ArticleInfectious diseases and therapy2026
How Status Quo Bias Shapes Willingness, Uptake, and Adherence to PrEP Among Chinese MSM: A Behavioral Economics Perspective.
Article in Infectious diseases and therapy, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers, 1 of them a synthesis that pooled it.
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Who cites it
2 citing papers in PubMed, 1 synthesis or guideline pooled it.
- The Impact of Behavioural Economics-Informed Interventions on the Care Cascade for Sexually Transmitted and Blood-Borne Infections: A Systematic Review of Randomized Controlled Trials.Journal of the International AIDS Society · 2026Pooled it
- Moderating Role of Condom-Use Inertia on the Association Between Status Quo Bias and Pre-Exposure Prophylaxis Resistance Intention Among Chinese Men Who Have Sex With Men: Cross-Sectional Study.JMIR public health and surveillance · 2026Article
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8 authors.
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Abstract
introductionImplementing pre-exposure prophylaxis (PrEP) is hindered by a significant "PrEP Cliff", a sharp decline from willingness to uptake and adherence. This study aimed to integrate status quo bias theory with a dual-process model, seeking to understand how this bias influences the PrEP cascade among men who have sex with men (MSM) in China.
methodsA cross-sectional survey was conducted among 1022 MSM across six provinces in China from November 2024 to February 2025. Through regression models, we tested a moderated mediation framework to examine how status quo bias influenced PrEP willingness, uptake, and adherence, focusing on the mediating role of PrEP resistance intention and the moderating role of condom-use inertia.
resultsParticipants were generally young (≤ 30 years; 63.1%), mostly unmarried (88.5%), and well-educated (89% with a bachelor's degree or higher). The "PrEP Cliff" was evident, characterized by high awareness (91.3%) and willingness among non-users (58.9%), but low uptake (46.2%) and poor adherence, with 53.4% of users self-reporting lower adherence. In the initiation phase (willingness and uptake), PrEP resistance intention significantly mediated the associations of transition costs and social norms on PrEP cascade outcomes. Condom-use inertia significantly moderated this mediation pathway by strengthening the associations of transition costs (β = 0.06, 95% CI 0.01 to 0.11) and social norms (β = - 0.05, 95% CI - 0.10 to 0.00) on PrEP resistance intention. However, the mechanism shifted during the adherence phase. Adherence was instead predominantly predicted by the direct associations of transition costs (β = - 0.44, 95% CI - 0.64 to - 0.23) and social norms (β = 0.56, 95% CI 0.38 to 0.74).
conclusionThis study provides an evidence-based framework for clinicians and public health programs to design stage-specific interventions tailored to the distinct psychological barriers that dominate each phase.
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