Socioeconomic status differences in PrEP acceptability and comprehension of PrEP messaging: Implications for policies and programs

Background: Although PrEP is a promising new prevention strategy, studies indicate wide ranges of acceptability and attitudes. Knowledge about PrEP is low, and little is known about the most effective means of communicating PrEP information to diverse populations. This NIH-funded study examined the impact of different PrEP messaging factors on acceptability and comprehension.

Methods: 270 MSM and transgender women (34% Black, 25% Latino) were presented with educational information about PrEP and completed computerized surveys. Educational information varied by specificity (i.e., verbatim versus gist presentation of PrEP efficacy data) and delivery method (i.e., via health educator or computer). Measures included willingness to take PrEP and comprehension of message components (e.g., correct use, potential side effects).

Results: PrEP acceptability was higher for those with less education and lower income (49% versus 36%, p < .05); however, low SES participants had a harder time understanding PrEP messaging. Only 60% of low SES participants answered all comprehension questions correctly, compared to over 80% of high SES participants (p < .001). Strongest effects were observed for questions about partial efficacy and proper use. For low SES participants, comprehension was impacted by message delivery, such that 74% of those who received information from a health educator got all comprehension questions correct, compared to only 48% of those who received the message via computer (p < .01). For those with low education, comprehension was also impacted by specificity (p < .05).

Conclusion: PrEP messaging must be tailored to insure comprehension of critical information, especially by vulnerable populations.