Barcelona 2013
Barcelona 2013
Abstract book - Abstract - 549
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Conference Details
International Committee
Plenary Speakers
Presenting Speakers
Scientific Committee
Abstract #549  -  Theory-and evidence based messageing for male circumcision uptake
  30.4: 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

  Presenting Author:   Prof Deven Hamilton - Battelle, United States
  Additional Authors:  Dr. Fulgentius Baryarama,  
Results of three RCTs led the Zimbabwe Ministry of Health and Child Welfare (MOHCW) to develop and prepare to roll out a male circumcision (MC) program as part of the national HIV prevention strategy. Critical to the success of this program is to design theory-driven evidence-based communication to motivate men to accept MC when it is offered. The Integrated Behavioral Model (IBM) was applied as the framework to investigate attitudinal, normative, and personal agency factors determining MC uptake motivation, in order to subsequently design evidence-based messaging. A quantitative survey was conducted to identify key beliefs that best explain men?s motivation to uptake MC, and that could be targeted by persuasive communication messaging.
Method / Issue:
An elicitation study was first conducted with a sample of men in Zimbabwe to identify beliefs underlying each IBM construct that may affect MC motivation. Results informed the quantitative questionnaire designed to measure the strength of each belief. These included 38 behavioral beliefs about getting circumcised, injunctive normative beliefs about whether 21 sources of influence encourage MC, and descriptive norm beliefs about whether 4 sources of influence would get circumcised. These beliefs were measured on 5-point agree-disagree scales. Control beliefs were assessed by asking respondents to rate on a 5-point scale how difficult versus easy each of the 29 facilitators or constraints make it to get circumcised. Efficacy beliefs were measured by asking respondents to rate how certain they are that they could get circumcised if faced with each of 15 constraints. MC Intention was measured on a 5-point agree-disagree scale. Surveys were conducted with a representative household-based sample of 1,201 men (96% participation) 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. Multiple regression analyses were conducted with data of 1,085 uncircumcised men, to identify IBM constructs and underlying beliefs best explaining MC motivation.
Results / Comments:
Attitude, Injunctive Norm, Descriptive Norm, Perceived Control and Self-Efficacy were computed from belief items with high internal consistency. All 5 constructs were significant in explaining MC Intention (R=0.71). All but 3 Behavioral beliefs and all Normative, Control and Efficacy beliefs were significantly correlated with Intention. Stepwise regression of beliefs underlying each construct resulted in 13 Behavioral beliefs, 5 Injunctive Norm beliefs, 4 Descriptive Norm beliefs, 10 Control beliefs, and 6 Efficacy beliefs significantly explaining Intention. A final stepwise regression including all prior significant beliefs across the 5 IBM constructs found 5 Behavioral beliefs, 3 Injunctive normative beliefs, 3 Efficacy beliefs, and 3 Control beliefs independently and significantly explain MC intention (R=0.74). Analyses of subgroups by urban-rural and age resulted in different sets of beliefs significant in explaining Intention.
We identified key beliefs underlying each of the IBM constructs that explain MC intention, and differentiate between high versus low intenders. The next steps toward developing evidence-based MC communications involved designing messages based on these findings, integrating messages into cohesive presentation, and testing the effect of the messages in changing the targeted beliefs and MC motivation.
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