Understanding STI testing behaviour among young people in New South Wales, Australia: The contribution of fears and worries in the context of an extended health belief model.
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The present study investigated how cognitive determinants and emotional determinants, in particular fears and worries, relate to STI testing behaviour. A survey was conducted online among 906 participants aged 16 to 26 years who completed a digital questionnaire about sexuality, sexual health, STI testing behaviours and cognitive and emotional factors potentially influencing testing behaviours. The cognitive factors were specified by an extended health belief model (HBM) and encompassed perceived risk and severity of STIs, perceived pros and cons of STI testing, and perceived behavioural control over STI testing behaviour. Emotional factors referred to fears and worries about STIs and STI testing. All cognitive variables of the extended HBM, as well as fears and worries, were found to be univariately associated with STI testing behaviour. In multivariate analysis, perceived behavioural control was found to add to HBM variables. As predicted the relation between fears and worries and STI testing was mediated by cognitive variables, but only the combination of extended HBM variables reduced the association between fears and worries and STI testing behaviour to non-significance; individual cognitive variables did not significantly mediate this association. Results of this study suggest that emotions influence cognitions in explaining STI testing behaviour. Fears and worries affect threat perception as well as evaluation of the behaviour, suggesting that threat appraisal and coping appraisal are intricately related and may not work in parallel as suggested by classic social cognitive models. Limitations and implications of the study are discussed.