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Behavior change pathways to voluntary medical male circumcision: narrative interviews with circumcision clients in Zambia.

Price JE, Phiri L, Mulenga D, Hewett PC, Topp SM, Shiliya N, Hatzold K - PLoS ONE (2014)

Bottom Line: Findings highlight intervention opportunities to increase VMMC uptake.Expanding service access is also needed to meet current demand.Improving clinic efficiencies and introducing time-saving procedures and advance scheduling options should be considered.

View Article: PubMed Central - PubMed

Affiliation: Population Council, Zambia Office, Lusaka, Zambia.

ABSTRACT
As an HIV prevention strategy, the scale-up of voluntary medical male circumcision (VMMC) is underway in 14 countries in Africa. For prevention impact, these countries must perform millions of circumcisions in adolescent and adult men before 2015. Although acceptability of VMMC in the region is well documented and service delivery efforts have proven successful, countries remain behind in meeting circumcision targets. A better understanding of men's VMMC-seeking behaviors and experiences is needed to improve communication and interventions to accelerate uptake. To this end, we conducted semi-structured interviews with 40 clients waiting for surgical circumcision at clinics in Zambia. Based on Stages of Change behavioral theory, men were asked to recount how they learned about adult circumcision, why they decided it was right for them, what they feared most, how they overcame their fears, and the steps they took to make it to the clinic that day. Thematic analysis across all cases allowed us to identify key behavior change triggers while within-case analysis elucidated variants of one predominant behavior change pattern. Major stages included: awareness and critical belief adjustment, norming pressures and personalization of advantages, a period of fear management and finally VMMC-seeking. Qualitative comparative analysis of ever-married and never-married men revealed important similarities and differences between the two groups. Unprompted, 17 of the men described one to four failed prior attempts to become circumcised. Experienced more frequently by older men, failed VMMC attempts were often due to service-side barriers. Findings highlight intervention opportunities to increase VMMC uptake. Reaching uncircumcised men via close male friends and female sex partners and tailoring messages to stage-specific concerns and needs would help accelerate men's movement through the behavior change process. Expanding service access is also needed to meet current demand. Improving clinic efficiencies and introducing time-saving procedures and advance scheduling options should be considered.

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Related in: MedlinePlus

VMMC Behavior Change Triggers and Uptake Within and Across Cases (n = 40).
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pone-0111602-g001: VMMC Behavior Change Triggers and Uptake Within and Across Cases (n = 40).

Mentions: To validate this overall interpretation of the data we examined conformity to and divergence from the predominant behavior change pattern for each of the 40 men. Figure 1 visualizes this case-by-case examination. Varied experiences at the VMMC-seeking stage are indicated in the last column of the figure which shows the number of attempts each man has made to receive surgical circumcision. Rather than to suggest a linear process of change from one discrete stage to the next, we offer this synthesis to approximate and “see,” in one view, the variable behavior change and VMMC-seeking experiences within our whole study population.


Behavior change pathways to voluntary medical male circumcision: narrative interviews with circumcision clients in Zambia.

Price JE, Phiri L, Mulenga D, Hewett PC, Topp SM, Shiliya N, Hatzold K - PLoS ONE (2014)

VMMC Behavior Change Triggers and Uptake Within and Across Cases (n = 40).
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4222873&req=5

pone-0111602-g001: VMMC Behavior Change Triggers and Uptake Within and Across Cases (n = 40).
Mentions: To validate this overall interpretation of the data we examined conformity to and divergence from the predominant behavior change pattern for each of the 40 men. Figure 1 visualizes this case-by-case examination. Varied experiences at the VMMC-seeking stage are indicated in the last column of the figure which shows the number of attempts each man has made to receive surgical circumcision. Rather than to suggest a linear process of change from one discrete stage to the next, we offer this synthesis to approximate and “see,” in one view, the variable behavior change and VMMC-seeking experiences within our whole study population.

Bottom Line: Findings highlight intervention opportunities to increase VMMC uptake.Expanding service access is also needed to meet current demand.Improving clinic efficiencies and introducing time-saving procedures and advance scheduling options should be considered.

View Article: PubMed Central - PubMed

Affiliation: Population Council, Zambia Office, Lusaka, Zambia.

ABSTRACT
As an HIV prevention strategy, the scale-up of voluntary medical male circumcision (VMMC) is underway in 14 countries in Africa. For prevention impact, these countries must perform millions of circumcisions in adolescent and adult men before 2015. Although acceptability of VMMC in the region is well documented and service delivery efforts have proven successful, countries remain behind in meeting circumcision targets. A better understanding of men's VMMC-seeking behaviors and experiences is needed to improve communication and interventions to accelerate uptake. To this end, we conducted semi-structured interviews with 40 clients waiting for surgical circumcision at clinics in Zambia. Based on Stages of Change behavioral theory, men were asked to recount how they learned about adult circumcision, why they decided it was right for them, what they feared most, how they overcame their fears, and the steps they took to make it to the clinic that day. Thematic analysis across all cases allowed us to identify key behavior change triggers while within-case analysis elucidated variants of one predominant behavior change pattern. Major stages included: awareness and critical belief adjustment, norming pressures and personalization of advantages, a period of fear management and finally VMMC-seeking. Qualitative comparative analysis of ever-married and never-married men revealed important similarities and differences between the two groups. Unprompted, 17 of the men described one to four failed prior attempts to become circumcised. Experienced more frequently by older men, failed VMMC attempts were often due to service-side barriers. Findings highlight intervention opportunities to increase VMMC uptake. Reaching uncircumcised men via close male friends and female sex partners and tailoring messages to stage-specific concerns and needs would help accelerate men's movement through the behavior change process. Expanding service access is also needed to meet current demand. Improving clinic efficiencies and introducing time-saving procedures and advance scheduling options should be considered.

Show MeSH
Related in: MedlinePlus