Development of a psychometric tool to measure community solidarity among sexual minorities: Evidence from a pay-it-forward randomized controlled trial

• Type of Material: Article
• Authors: Anne Sung, University of Connecticut School of Medicine; Tiange P. Zhang, University of North Carolina, Project-China; Wenting Huang, Emory University; Weiming Tang, University of North Carolina, Project-China; Marcus Alexander, Yale University; Laura Forastiere, Yale University; Navin Kumar, Yale University; Brian J. Hall, New York University, Shanghai; Yusuf Ransome, Yale School of Public Health; Kevin D. Dieckhaus, University of Connecticut School of Medicine; Dan Wu, University of North Carolina, Project-China; Joseph D. Tucker, University of North Carolina, Project-China; Fan Yang, University of North Carolina, Project-China
• Language: English
• Date: 2022-06-08
• Publisher: Wolters Kluwer Health Inc.
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2022 American Sexually Transmitted Diseases Association. All rights reserved.
• Final Published Version (URL): https://doi.org/10.1097%2FOLQ.0000000000001659
• Title of Journal or Parent Work: Sexually Transmitted Diseases
• Volume: 49
• Issue: 9
• Start Page: 628
• End Page: 634
• Grant/Funding Information: This study was supported by NIAID K24AI143471 and NIAID R01AI158826.
• Keywords: men who have sex with men; community solidarity; Sexually transmitted infections; factor analysis
• Research Categories: Health Sciences, Public Health

Abstract

Background: Community solidarity is increasingly important in public health. However, few studies have examined solidarity in relation to health outcomes. The purpose of this study was to develop a psychometric tool to measure solidarity among Chinese men-who-have-sex-with-men (MSM) and assess whether community solidarity relates to differences in STI testing. Methods: We used data from the Pay-it-Forward randomized controlled trial of 301 men from Beijing and Guangzhou, China. MSM were randomized into pay-it-forward (participants receive free gonorrhea/chlamydia testing as gifts and choose to donate towards subsequent MSM’s tests), pay-what you-want, and standard payment arms. Following testing decision, participants completed a cross-sectional questionnaire to assess community solidarity. Factor analysis was conducted to identify dimensions of solidarity. The solidarity factors were compared across study arms and assessed against gonorrhea/chlamydia test uptake in multivariable logistic regression. Results: 288 participants responded to the survey. We identified three latent community solidarity factors: engagement, social network support, and sense of belonging. Several items related to belonging were significantly greater among participants in the pay-it-forward scenario compared to those assigned to other scenarios. Higher sense of belonging was associated with higher odds of gonorrhea and chlamydia test uptake. Conclusion: Community solidarity among MSM in China can be characterized by three factors: engagement, social network support, and sense of belonging. Sense of belonging was higher in the pay-it-forward intervention arm and may be associated with the uptake of gonorrhea/chlamydia test. Future studies are warranted to confirm the psychometric structure of community solidarity and further investigate behavioral mechanisms of pay-it-forward.