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Behavior change pathways to male circumcision

July 1, 2013. Behavior change pathways to male circumcision. narrative interviews with VMMC clients in Zambia. J. Price 1 , D. Mulenga 1 , L. Phiri 1 , P. Hewett 1 , K. Hatzold 2 , N. Shiliya 3 , K. Bowa 4.

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Behavior change pathways to male circumcision

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  1. July 1, 2013 Behavior change pathways to male circumcision narrative interviews with VMMC clients in Zambia J. Price1, D. Mulenga1, L. Phiri1, P. Hewett1,K. Hatzold2, N. Shiliya3, K. Bowa4 1Population Council/Zambia, 2Population Services International/Zimbabwe, 3Society for Family Health/Zambia, 4Copperbelt University/Zambia

  2. Objectives and Methods • Context • Zambia has experienced challenges in meeting VMMC targets in adult men Objective Understand the behavior change process leading to MC-seeking • Methods and theorized behavior change stages • Narrative interviews with 40 clients (≥18 years old) waiting for surgical MC at two Lusaka clinics Stage 4 Stage 2 Stage 3 Initial exposure and impressions Contemplation Early action Commitment Stage 1

  3. Empirically-Determined Behavior Change Stages Stage 4 Stage 1 Stage 2 Stage 3 Exposure and belief adjustment Personalizing benefits and normingpressures Conquering fears and taking charge of Self Taking action, seeking MC

  4. Most Frequently Cited Sources of Information, Advantages, and Fears Sources of Information Perceived Advantages Major Fears (n=40)

  5. I met a girl named Alice . . . Stage 1: Exposure & Belief Adjustment I met a girl named Alice. She’s the one who enticed me to do it. She came with a brochure and said, ‘you know honey, there’s something we can do to make our love more enjoyable.’

  6. Main Beliefs Adjusted I started to see it wasn’t dangerous because even my best friend from the Copperbelt did it. He even showed me. I then talked to my wife and she said “you can do it.” • MC is . . . • safe • for Christians too • for all ethnic groups • for adult men

  7. I feel different . . . Stage 2: Personalization & Norming Pressures This is an honest opinion, everyone around me has gone [for MC], so I feel different. Now I just feel like I’m doing what a man is supposed to do. I was being left behind because everyone else has done it. • If I don’t get circumcisedI’ll be . . . • left behind • missing out • left out of the group • different • If I do get • circumcisedI’ll be . . . • responsible • sexually appealing • clean • safe • like other men

  8. I’m ready now . . . Stage 3: Conquering Fears, Taking Charge I’m ready now, I even feel desperate. It’s like having a thirst. I need to drink water. • I told myself . . . • just forget your fears • no pain lasts forever • all wounds eventually heal • other men have done it • it’s my . . . • life • health • future

  9. I woke up, had my breakfast, brushed my teeth, and came here . . . Stage 4: Commitment, MC Seeking Number of attempts to obtain MC I wanted to go to X clinic but found it was a celebration of cancer day today. I went home and sat down in my chair. Then I thought to myself, since I decided that I should do this today, why don't I try Y?

  10. Service-Side Access Barriers Encountered Number of attempts to obtain MC = 20 failed MC attempts in total

  11. Implications and Recommendations Stage 4 Stage 1 Stage 2 Stage 3 Exposure and belief adjustment Personalizing benefits and normingpressures Conquering fears and taking charge of Self Taking action, seeking MC • Continue multi-media communications • But diversify messaging • Target network members • Emphasize secondary benefits • Emphasize that MC is for EveryMAN Advertise clinic hours, days Introduce by-appointment-only scheduling Improve processing efficiencies at the clinic Use MC-experienced men (I did it, so can you) Offer more places where men can get their specific questions answered

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