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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

基本信息

批准号：
8207943
负责人：
DANIEL E MONTANO
金额：
$ 63.27万
依托单位：
BATTELLE CENTERS/PUB HLTH RES & EVALUATN
依托单位国家：
美国
项目类别：
财政年份：
2009
资助国家：
美国
起止时间：
2009-01-01 至 2013-12-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8207943
关键词：
AIDS prevention AIDS/HIV problem Accounting Acquired Immunodeficiency Syndrome Adolescent Adopted Adoption Adult Affect Africa South of the Sahara Age Am 80 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 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 research study rural area standard of care success transmission process uptake

项目摘要

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(由申请者提供)：男性包皮环切术(MC)已被明确证明可显著减少艾滋病毒在女性与男性之间的传播，人们逐渐达成共识，认为MC应作为一项战略纳入全面的艾滋病毒预防计划(世卫组织/联合国艾滋病规划署，2006年；世卫组织/联合国艾滋病规划署，2007年；卫生部，2007年)。国际机构、方案和国家正在考虑如何实施基础广泛的MC方案。专家建议，在那些艾滋病毒高度流行(艾滋病毒流行率为15%)、感染主要通过异性传播传播、以及有很大比例的男性(例如，80%)未接受割礼的国家，应将执行工作放在最优先的位置。津巴布韦就是这样一个国家，正在考虑发展一项MC计划。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，是此类计划成功的关键。我们建议使用一个强大的理论模型作为框架，在津巴布韦的四个关键群体中调查环境(能力、结构、文化)和个人(态度、规范、个人代理)因素对MC相关行为动机的影响：政策制定者、临床医生、青少年和成年男性，以及青少年男孩的预期父母和父母。运用Jaccard等人(2002)的研究框架和综合行为模型(IBM)，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，以确定模型中与MC行为相关的每个结构的显著问题；2)对每个研究小组的代表性样本进行基于定性结果的定量调查，分析将确定每个小组影响MC相关行为动机的最重要因素；3)调查结果将被用来设计教育信息，以激励每个研究小组的MC行为，并将进行信息测试，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全面MC计划的基础。这项研究将由一组调查人员进行，他们已经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可能受到MC计划影响的所有角度的人。如果政策决定在津巴布韦实施MC计划，这项研究将提供关于如何激励临床医生在他们的男性患者和有青春期男孩的父母中鼓励MC的关键信息。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(MOHCW)能够根据MC的可接受性和卫生系统的能力，确定MC的目标群体的优先次序。总之，这项研究将为津巴布韦卫生部计划推出和传播MC计划提供重要信息。公共卫生相关性：男性包皮环切术(MC)已被证明可大大减少艾滋病毒在女性与男性之间的传播，因此，人们逐渐达成共识，认为应在艾滋病毒高度流行(艾滋病毒流行率为15%)、感染主要通过异性传播以及大部分男性(例如，80%)未接受割礼的国家实施MC。这项拟议的研究将在津巴布韦的四个关键群体中调查影响支持或反对MC相关行为动机的环境和个人因素：政策制定者、临床医生、青少年和成年男性，以及青少年男孩的预期父母和父母。调查结果将为津巴布韦政策制定者提供重要信息，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。