Barcelona 2013
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| Abstract #552 - Theory-and evidence based messageing for male circumcision uptake | ||||
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Session: 30.3: Theory-and evidence based messageing for male circumcision uptake (Lunchtime) on Tuesday @ 13.15-14.15 in Auditorium Chaired by Dr Danuta Kasprzyk, Dr Daniel Montano Authors: Presenting Author: Ms. Kayla Down - Battelle Memorial Research Institute, United States |
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| Additional Authors: Dr. Fulgentius Baryarama, | ||||
| Aim: Results of three RCTs led the Zimbabwe Ministry of Health and Child Welfare (MOHCW) to develop and roll out a male circumcision (MC) program as part of the national HIV prevention strategy. Critical to the success of this program was theory-driven evidence-based demand creation increasing men?s uptake of MC when offered. The Integrated Behavioral Model (IBM) was used as a framework to investigate attitudinal, normative, and personal agency factors determining motivation to uptake MC. An elicitation study with the planned target groups was the first step in applying the IBM framework to investigate drivers of MC motivation. The goal of the study was to elicit salient beliefs that may affect MC motivation and to design a quantitative survey instrument to subsequently measure these beliefs. | ||||
| Method / Issue: The qualitative interview guide elicited specific issues with respect to each IBM construct. Questions were designed to elicit: 1) positive and negative behavioral beliefs about getting circumcised, 2) sources of normative influence about getting circumcised, and 3) factors that may make it easier or harder to get circumcised. Interviews were conducted with a representative household-based sample of 33 men aged 18-30, about evenly split between two urban (Harare, Bulawayo) and two rural (Mutoko, Matobo) sites in Zimbabwe, representing Shona and Ndebele ethnic groups. Interviews were recorded and transcribed verbatim. Content analysis extracted specific beliefs mentioned, combining similar items and excluding those seldom mentioned, resulting in comprehensive lists of beliefs with respect to each IBM construct. Original wording was retained as much as possible. | ||||
| Results / Comments: The coding resulted in the identification of 38 positive and negative beliefs about getting circumcised, 21 sources of normative influence, 14 facilitators and 15 constraints. A wide range of positive and negative beliefs were elicited such as: health benefits including protection from STIs and HIV; increased sexual pleasure, positive impact on sexual performance; positive effects on longevity, ability to take care of family; concerns about complications such as bleeding, swelling, infertility, and healing time; temptations for increased risky behavior; and stigma from peers, females. Sources of influence included friends, family members, MOHCW, wife/girlfriend, media, culture, clinicians, and traditional leaders. Facilitators included environmental factors such as availability of circumcision services in local clinics, local chief support. Barriers included concerns over availability of MC supplies, attendance by female nurses, cost, and culture. These beliefs were turned into quantitative surveys with scales measuring attitudes, norms, and personal agency, retaining original phrasing. | ||||
| Discussion: We identified IBM construct beliefs elicited from the target group of men in Zimbabwe. These results identified issues but did not tell us which beliefs were important to target to change MC motivation. The critical next step was to measure beliefs quantitatively. This was done to assess the prevalence of the beliefs, indicating which ones were most important to target with messages. In addition, we wanted to determine which beliefs were most strongly associated with MC motivation among men, and also to determine which ones best differentiate men who are motivated to get MC from those less motivated. | ||||
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