University of North Carolina at Chapel Hill Graduate School
Doi
Abstract
Prosocial interventions encourage voluntary actions that benefit others to achieve medical and/or public health outcomes. Pay-it-forward is a prosocial approach that includes offering an individual a gift (an STD test) and then asking if that individual would like to give a gift to another person. This approach has shown promising results among gay, bisexual, and men who have sex with men (GBMSM) in China, but there is limited understanding about the participant experience and how this intervention works. This study aims to understand prosocial behavior, recipient gratitude and warm glow, and the impact these behaviors can have on an individual’s health. Aim 1 synthesizes the peer reviewed literature on prosocial interventions used to promote public health and medical outcomes using a systematic review. Aim 2 and 3 explore the experience of the participant in pay-it-forward specifically by describing their experience when they receive a gift and the warm glow feeling that people feel when they give to others (Aim 2) and determine whether receiving a gift from pay-it-forward is associated with transient feelings of gratitude and changes in a biomarker, oxytocin (Aim 3). Our systematic review was informed by the Cochrane handbook, and the data extraction and synthesis consisted of three parts: a transformation of quantitative and mixed methods results to qualitative narratives, a data based convergent synthesis, and a meta-aggregation interpretation.Our analysis of pay-it-forward was conducted using data from a two-armed study comparing pay-it-forward to a free test as part of a research study. In aim 2 we conducted a qualitative thematic analysis to identify facilitators and barriers of implementing pay-it-forward. In aim 3 we conducted confirmatory factor analysis, difference-in-difference models, and regression analysis to compare demographic differences between the two groups and individual oxytocin changes.The systematic review found that individual interests and community connectedness are vital aspects of prosocial interventions. Informed by the systematic review, the qualitative analysis found that the pay-it-forward approach highlights the need for connection, support, and health services for gay men in China. The quantitative analysis found insignificant results but determined that the STD clinic environment itself may alter the biomarker.Doctor of Philosoph
