Environmental/Behavioral Factors Shaping Circumcision Decisions in Zimbabwe

描述（由申请人提供）：男性包皮环切术（MC）已被明确证明可大幅减少女性向男性传播艾滋病毒，并且逐渐形成共识，认为应将MC作为一项战略纳入全面的艾滋病毒预防方案（WHO/UNAIDS，2006; WHO/UNAIDS，2007; MOHCW，2007）。国际机构、计划和国家正在考虑如何实施基础广泛的MC计划。专家们建议，执行工作应列为最高优先事项的国家是艾滋病毒高度流行的国家（艾滋病毒流行率> 15%），感染主要通过异性性传播，以及大部分男子（例如，> 80%的人没有割包皮。津巴布韦就是这样一个国家，正在考虑制定一个MC方案。这种方案成功的关键是进行研究，以确定影响执行的因素，同时保持成功的艾滋病毒预防战略。我们建议使用一个强大的理论模型作为一个框架，调查环境（能力，结构，文化）和个人（态度，规范，个人机构）的因素影响动机MC相关的行为在津巴布韦的四个关键群体：政策制定者，临床医生，青少年和成年男子，和准父母和父母的青春期男孩。本研究采用Jaccard等人（2002）的研究框架和IBM的整合行为模型（Integrated Behavioral Model），主要分为四个步骤：1）对每个被试进行定性访谈，以确定模型中每个被试在MC行为方面的显著问题; 2）根据定性结果设计的定量调查将对每个研究组的代表性样本进行管理，分析将找出影响每个群体的MC相关行为动机的最重要因素; 3）调查结果将用于设计教育信息，以激励每个研究组的MC行为，和信息测试将进行评估的可接受性和对行为动机的影响; 4）提供给津巴布韦决策者的结果将作为基础，设计一个全面的MC计划，可能是有效的。这项研究将由一组调查人员进行，他们在津巴布韦建立了一个合作研究小组。数据收集将在两个城市和两个农村地区进行，包括两个主要民族群体，因此将最大限度地纳入受MC计划影响的人的所有观点。如果一项政策决定是在津巴布韦实施MC计划，这项研究将提供关键信息，如何激励临床医生，鼓励他们的男性患者和父母与青春期男孩MC。研究将评估MC的可接受性和潜在需求，并确定培训需求。它将使卫生和儿童福利部能够根据儿童保育的可接受性和卫生系统的能力，优先考虑儿童保育的目标群体。总之，这项研究将为津巴布韦卫生和儿童福利部计划推出和传播MC计划提供重要信息。公共卫生相关性：男性包皮环切术（MC）已被证明可以大大减少女性对男性的艾滋病毒传播，因此逐渐形成的共识是，应该在艾滋病毒高度流行（艾滋病毒流行率> 15%），感染主要通过异性传播，以及大部分男性（例如，> 80%的人没有割包皮。拟议的研究将调查环境和个人因素的影响动机或反对MC相关的行为在津巴布韦的四个关键群体：政策制定者，临床医生，青少年和成年男子，以及准父母和青少年男孩的父母。调查结果将为津巴布韦决策者提供重要信息，以计划推出和传播MC计划，并最大限度地提高成功的可能性。

DESCRIPTION (provided by applicant): Male circumcision (MC) has been clearly demonstrated to substantially reduce female to male transmission of HIV, and there is evolving consensus that MC should be included as a strategy in comprehensive HIV prevention programs (WHO/UNAIDS, 2006; WHO/UNAIDS, 2007; MOHCW, 2007). International agencies, programs, and countries are considering how to implement broad-based MC programs. Experts recommend that the countries where implementation should have highest priority are those where HIV is hyperendemic (HIV prevalence > 15%), infection is spread mainly through heterosexual transmission, and where a large proportion of men (e.g., > 80%) are not circumcised. Zimbabwe is such a country and is considering development of an MC program. Critical to the success of such a program is research to determine factors affecting the implementation, while maintaining successful HIV prevention strategies. We propose to use a strong theoretical model as a framework to investigate environmental (capacity, structure, culture) and individual (attitude, normative, personal agency) factors influencing motivation regarding MC-related behaviors among four key groups in Zimbabwe: policy makers, clinicians, adolescent and adult men, and expectant parents and parents of adolescent boys. Applying a framework adapted from Jaccard, et al (2002) and the Integrated Behavioral Model (IBM) we will carry out the research in four main steps: 1) Qualitative interviews conducted with each group will be used to identify salient issues relevant to each construct in the model with respect to MC behaviors; 2) Quantitative surveys, designed based on qualitative results, will be administered to representative samples of each study group, and analyses will identify the most important factors affecting MC-related behavior motivation for each group; 3) Survey results will be used to design educational messages to motivate MC behavior for each study group, and message testing will be carried out to assess acceptability and impact on behavioral motivation; 4) Results provided to Zimbabwe policy-makers will serve as the basis for designing a comprehensive MC program that is likely to be effective. This research will be carried out by a team of investigators who have developed a collaborative research team in Zimbabwe. Data collection will be done in two urban and two rural areas, including both major ethnic groups, and thus will maximize inclusion of all perspectives of people who would be impacted by an MC program. If a policy decision is made to implement an MC program in Zimbabwe, this study will provide key information on how to motivate clinicians to encourage MC among their male patients and parents with adolescent boys. The research will assess the acceptability and potential demand for MC, and determine training needs. It will allow the Ministry of Health and Child Welfare (MOHCW) to prioritize the target groups for MC, based on MC acceptability and health system capacity. In sum, this research will provide vital information for the MOHCW in Zimbabwe to plan the roll out and dissemination of a MC program. PUBLIC HEALTH RELEVANCE: Male circumcision (MC) has been demonstrated to substantially reduce female to male transmission of HIV, so there is evolving consensus that MC should be implemented in countries where HIV is hyperendemic (HIV prevalence > 15%), infection is spread mainly through heterosexual transmission, and where a large proportion of men (e.g., > 80%) are not circumcised. The proposed research will investigate environmental and individual factors influencing motivation for or against MC-related behaviors among four key groups in Zimbabwe: policy makers, clinicians, adolescent and adult men, and expectant parents and parents of adolescent boys. Findings will provide vital information for Zimbabwe policy-makers to plan the roll out and dissemination of a MC program and maximize likelihood of success.