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Identification of Key Beliefs Explaining Male Circumcision Motivation Among Adolescent Boys in Zimbabwe: Targets for Behavior Change Communication

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Abstract

Male circumcision (MC) significantly reduces HIV acquisition among men, leading WHO/UNAIDS to recommend high HIV and low MC prevalence countries circumcise 80% of adolescents and men age 15–49. Despite significant investment to increase MC capacity only 27% of the goal has been achieved in Zimbabwe. To increase adoption, research to create evidence-based messages is greatly needed. The Integrated Behavioral Model (IBM) was used to investigate factors affecting MC motivation among adolescents. Based on qualitative elicitation study results a survey was designed and administered to a representative sample of 802 adolescent boys aged 13–17 in two urban and two rural areas in Zimbabwe. Multiple regression analysis found all six IBM constructs (2 attitude, 2 social influence, 2 personal agency) significantly explained MC intention (R2 = 0.55). Stepwise regression analysis of beliefs underlying each IBM belief-based construct found 9 behavioral, 6 injunctive norm, 2 descriptive norm, 5 efficacy, and 8 control beliefs significantly explained MC intention. A final stepwise regression of all the significant IBM construct beliefs identified 12 key beliefs best explaining intention. Similar analyses were carried out with subgroups of adolescents by urban–rural and age. Different sets of behavioral, normative, efficacy, and control beliefs were significant for each sub-group. This study demonstrates the application of theory-driven research to identify evidence-based targets for the design of effective MC messages for interventions to increase adolescents’ motivation. Incorporating these findings into communication campaigns is likely to improve demand for MC.

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Acknowledgements

The research reported in this publication was supported by the National Institute of Mental Health of the National Institutes of Health under Award Number R01MH083594. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. We would like to acknowledge the study participants and the University of Zimbabwe, ZiCHIRe Program, Department of Community Medicine study team for their collaboration in all phases of this study.

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Authors and Affiliations

  1. Department of Family & Child Nursing, University of Washington, Seattle, WA, USA

    Danuta Kasprzyk & Daniel E. Montaño

  2. Department of Global Health, University of Washington, Seattle, WA, USA

    Danuta Kasprzyk & Daniel E. Montaño

  3. Department of Community Medicine, University of Zimbabwe, Harare, Zimbabwe

    Mufuta Tshimanga

  4. Center for Studies in Demography and Ecology, University of Washington, Seattle, WA, USA

    Danuta Kasprzyk, Deven T. Hamilton & Daniel E. Montaño

  5. Department of Management and Marketing, The Hong Kong Polytechnic University, Hong Kong, Hong Kong

    Gerald J. Gorn

  6. Department of Family and Child Nursing, School of Nursing, University of Washington, Box 357262, Seattle, WA, 98195-7262, USA

    Danuta Kasprzyk

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  1. Danuta Kasprzyk
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Correspondence to Danuta Kasprzyk.

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Conflict of interest

Danuta Kasprzyk, Mufuta Tshimanga, Deven Hamilton, Gerald Gorn, and Daniel Montaño each declares that he/she has no conflict of interest.

Ethical Approval

All procedures performed in this study involving human subjects were in accordance with the ethical standards of the US institutional IRB and the Medical Research Council of Zimbabwe, and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Written informed consent was obtained from all individual participants included in the study.

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Kasprzyk, D., Tshimanga, M., Hamilton, D.T. et al. Identification of Key Beliefs Explaining Male Circumcision Motivation Among Adolescent Boys in Zimbabwe: Targets for Behavior Change Communication. AIDS Behav 22, 454–470 (2018). https://doi.org/10.1007/s10461-016-1664-7

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  • DOI: https://doi.org/10.1007/s10461-016-1664-7

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