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

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.

Condom embarrassment: coping and consequences for condom use in three countries.

This study investigates embarrassment related to condom purchase, carrying, storage, use, and disposal in three countries. We identify the consequences of purchase embarrassment for condom use and explore strategies that individuals use to cope with purchase-related embarrassment. Surveys were distributed in Shanghai, China and Seoul, Republic of Korea based on a survey developed and previously distributed in Vancouver, Canada. Despite different levels of development and differences in attitudes and policies toward sexuality in these countries, we find remarkably similar results. In all three countries, condom-related embarrassment extends beyond condom use to pre- and post-use situations. The embarrassment associated with purchasing condoms exceeds that of using condoms, and purchase-related condom embarrassment significantly and negatively impacts the frequency of condom use. Individuals use multiple coping strategies to combat purchase-related embarrassment until this embarrassment decreases with age and experience, and coping strategies are no longer needed to enable condom purchase. In short, embarrassment associated with condoms goes beyond embarrassment about condom use. Purchase-related embarrassment and the strategies individuals use to cope with this embarrassment must be considered in order to promote consistent condom use and improve sexual and reproductive health worldwide.

Coping with condom embarrassment.

This study assesses the embarrassment associated with purchasing, carrying, storing, using and disposing of condoms. It incorporates coping theory into the investigation of embarrassment by analysing the strategies individuals use to cope with embarrassment during condom purchase. The results of a survey show that individuals are embarrassed at various stages related to condom use. Purchasing condoms elicits the most embarrassment, followed by carrying and disposing, while using and storing are the least embarrassing. To cope with their embarrassment while purchasing condoms, people use multiple cognitive and behavioural coping strategies, with embarrassed people using more strategies. Both embarrassment and the number of strategies used decrease with age and experience. It appears that embarrassment associated with condoms remains a barrier to condom acquisition and consistent condom use, particularly among young adult populations. Coping strategies help individuals to bridge the gap between embarrassment and use.