Environmental/Behavioral Factors Shaping Circumcision Decisions in Zimbabwe

影响津巴布韦包皮环切决定的环境/行为因素

• 批准号: 7623001
• 负责人: DANIEL E MONTANO
• 金额: $ 65.33万
• 依托单位: BATTELLE CENTERS/PUB HLTH RES & EVALUATN
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-01-01 至 2012-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7623001
• 关键词: AIDS prevention; AIDS/HIV problem; Accounting; Acquired Immunodeficiency Syndrome; Adolescent; Adopted; Adoption; Adult; Affect; Africa South of the Sahara; Age; Attitude; Behavior; Behavioral; Behavioral Model; Cessation of life; Child; Child Welfare; Communication; Communities; Complex; Consensus; Country; Data Collection; Decision Making; Development; Effectiveness; Environment; Environment and Public Health; Environmental Policy; Ethnic group; Female; Gray unit of radiation dose; HIV; Health; Health Personnel; Health Policy; Health system; Heterosexuals; Individual; Infant; Infection; International Agencies; Interview; Investigation; Knowledge; Link; Male Adolescents; Male Circumcision; Methods; Modeling; Motivation; National Institute of Mental Health; Parents; Patients; Phase; Policies; Policy Maker; Prevalence; Prevention program; Prevention strategy; Public Health; Randomized Controlled Trials; Recruitment Activity; Reporting; Research; Research Design; Research Personnel; Sampling; Shapes; Structure; Sum; Surveys; System; Techniques; Testing; Theoretical model; Time; Training; Translating; USAID; World Bank; Zambia; Zimbabwe; aged; base; behavior change; boys; cohort; design; follow-up; male; meetings; member; men; mortality; programs; public health relevance; research study; rural area; standard of care; success; transmission process; uptake

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.

描述（由申请人提供）：男性包皮环切术（MC）已被清楚地证明可以大大减少艾滋病毒的女性向男性传播，并且越来越多的人认为应该将包皮环切术作为艾滋病毒综合预防规划的一项战略（WHO/UNAIDS, 2006; WHO/UNAIDS, 2007；卫生部，2007）。国际机构、项目和国家正在考虑如何实施基础广泛的MC项目。专家建议，实施工作应最优先考虑的国家是那些艾滋病毒高流行（艾滋病毒流行率为15%）、感染主要通过异性传播传播以及大部分男性（例如，80%）未行包皮环切术的国家。津巴布韦就是这样一个国家，正在考虑发展MC项目。这一方案成功的关键是研究确定影响实施的因素，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框架来调查影响津巴布韦四个关键群体（决策者、临床医生、青少年和成年男性、准父母和青春期男孩的父母）关于mc相关行为动机的环境（能力、结构、文化）和个人（态度、规范、个人代理）因素。应用Jaccard等人（2002）和集成行为模型（IBM）的框架，我们将分四个主要步骤进行研究：1)对每个小组进行定性访谈，以确定与MC行为相关的模型中每个结构相关的突出问题；2)根据定性结果设计定量调查，对每个研究组的代表性样本进行分析，找出影响每个组mc相关行为动机的最重要因素；3)根据调查结果设计激励每个研究组MC行为的教育信息，并进行信息测试以评估可接受性和对行为动机的影响；4)向津巴布韦政策制定者提供的结果将作为设计可能有效的综合MC计划的基础。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，因此将最大限度地纳入将受到MC计划影响的人们的所有观点。如果政策决定在津巴布韦实施MC计划，本研究将提供关于如何激励临床医生鼓励男性患者和青春期男孩的父母进行MC的关键信息。研究将评估管理的可接受性和潜在需求，并确定培训需求。它将允许卫生和儿童福利部（MOHCW）根据MC的可接受性和卫生系统的能力优先考虑MC的目标群体。总而言之，这项研究将为津巴布韦卫生部规划MC方案的推出和传播提供重要信息。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艾滋病毒的女性向男性传播，因此人们逐渐达成共识，认为应该在艾滋病毒高流行（艾滋病毒患病率为15%）、感染主要通过异性传播传播以及大部分男性（例如，80%）未行包皮环切术的国家实施包皮环切术。拟议的研究将调查在津巴布韦四个关键群体中影响支持或反对mc相关行为动机的环境和个人因素：决策者、临床医生、青少年和成年男子、准父母和青春期男孩的父母。调查结果将为津巴布韦决策者提供重要信息，以规划MC项目的推出和传播，并最大限度地提高成功的可能性。