Perceptions of the COVID-19 Vaccine and Other Adult Vaccinations in Malawi: A Qualitative Assessment.

In Malawi, various brands of the COVID-19 vaccine have been offered to the population, but factors including fear of side effects or other risks, uncertainty about benefits, and misinformation created hesitancy toward them. In early 2022, 4% of Malawians were fully vaccinated for COVID-19. Despite multiple promotion efforts, by August 2022, COVID-19 vaccination nationwide was around 15%. To increase COVID-19 vaccination uptake, the research team collected qualitative data in 4 districts with vaccine coverage levels ranging from 1% to 11%. This data collection happened during a cholera outbreak that began in March 2022 and the vaccination efforts to address it. Study participants included male and female members of the general population, social workers, people with comorbidities, health workers, and community leaders (224 participants total, 47% female). In focus group discussions (n=27) and in-depth interviews (n=17), participants compared COVID-19 vaccines with other adult vaccines, such as cholera and tetanus toxoid. A thematic analysis identified themes related to 3 research questions on COVID-19 vaccine concerns, confidence, and delivery affecting uptake. Differences in promotion, delivery (oral versus injection), COVID-19 vaccine card structure, the various brands and boosters, and vaccines being described as required or optional all played a role in distinguishing COVID-19 vaccines from other vaccines and creating suspicion or indifference. Barriers to vaccination in general, such as rumors or knowledge gaps, were amplified by how novel the COVID-19 vaccines were perceived to be and the changing guidance provided over time. By April 2023, more targeted campaign efforts helped increase vaccination rates to 28%. The findings contribute information about how individuals conceptualize and make decisions about adult vaccination, which can, in turn, inform strategies to integrate COVID-19 promotion and delivery with other disease responses in Malawi as well as routine health services in similar settings.

Propiedades psicométricas del cuestionario burnout para profesores universitarios en una muestra peruana / Psychometric properties of the burnout questionnaire for university professors in a Peruvian sample

Objetivo: se analizó la validez y confiabilidad del cuestionario burnout para profesores universitarios, que es una versión modificada de la adaptación española del Inventario Burnout de Maslach (MBI). Materiales y métodos: es un estudio psicométrico, transversal, de tipo instrumental, cuya muestra está conformada por 206 docentes de la Universidad Nacional Santiago Antúnez de Mayolo (Ancash, Perú), 164 varones y 42 mujeres, de 20 a 70 años de edad, 165 nombrados y 41 contratados, quienes participaron voluntariamente en el estudio. Resultados: el cuestionario cuenta con validez de contenido, para lo cual se consultó a ocho expertos y se determinó la V de Aiken, que presenta un valor aceptable igual a 0,91. La validez de constructo fue estimada tanto a través del análisis factorial exploratorio, en la cual la medida de Kaiser Meyer Olkin es igual a 0,87; como del análisis factorial confirmatorio en la que las puntuaciones de medida de ajuste son adecuadas para el burnout por docencia (RMSEA=0,07, CFI=0,87, TLI=0,86, NFI=0,77) y para el burnout por investigación (RMSEA=0,06, CFI=0,91, TLI=0,90, NFI=0,80). La validez discriminante se determinó mediante el índice de discriminación de los ítems, y todos obtuvieron puntuaciones superiores al mínimo aceptable (r=0,20). Asimismo, los resultados revelaron consistencia interna a través del coeficiente del alfa de Cronbach (a=0,92) y del omega (Ω=0,92). Conclusión: se confirmó que las propiedades psicométricas del cuestionario burnout para profesores universitarios son adecuadas, pues evidencia tener validez y confiabilidad para evaluar el burnout..(Au)

Objective: to analyze the validity and reliability of the burnout Questionnaire for university professors, which is a modified version of the Spanish adaptation of the Maslach Burnout Inventory (MBI). Materials and methods: this are a psychometric, cross-sectional, instrumental study, whose sample is made up of 206 professors from the Santiago Antunez de Mayolo National University (Ancash, Peru), 164 men and 42 women, aged 20 to 70 years. age, 165 appointed and 41 hired, who voluntarily participated in the development of the study. Results: it is found that the questionnaire has content validity, for which eight experts were consulted and Aiken's V was determined, which presents an acceptable value equal to 0,91. The construct validity estimated both through exploratory factor analysis, in which the Kaiser Meyer Olkin measure is equal to 0,87; as from the confirmatory factor analysis in which the adjustment measure scores are adequate for teaching burnout (RMSEA = 0,07, CFI = 0,87, TLI = 0,86, NFI = 0,77), and for research burnout (RMSEA = 0,06, CFI = 0,91, TLI = 0,90, NFI = 0,80). The discriminant validity determined by the discrimination index of the items, and all obtained scores higher than the minimum acceptable (r = 0,20). Likewise, the results reveal internal consistency through Cronbach's alpha coefficient (a = 0,92) and Omega (Ω = 0,92). Conclusion: It is confirmed that the psychometric properties of the burnout Questionnaire for university professors are adequate, since it shows validity and reliability to evaluate burnout..(Au)

Control of fibrosis by TGFß signalling modulation promotes redifferentiation during limited regeneration of mouse ear.

Transforming growth factor beta (TGFß) signalling is involved in several aspects of regeneration in many organs and tissues of primitive vertebrates. It has been difficult to recognize the role of this signal in mammal regeneration due to the low ability of this animal class to reconstitute tissues. Nevertheless, ear-holes in middle-age female mice represent a model to study the limited epimorphic-like regeneration in mammals. Using this model, in this study we explored the possible participation of TGFß signalling in mammal regeneration. Positive pSmad3 cells, as well as TGFß1 and TGFß3 isoforms, were detected during the redifferentiation phase in the blastema-like structure. Daily administration of the inhibitor of the TGFß intracellular pathway, SB431542, during 7 days from the re-differentiation phase, resulted in a decreased level of pSmad3 accompanied by a transitory higher growth of the new tissue, larger cartilage nodules, and new muscle formation. These phenotypes were associated with a decrease in the number of α-SMA-positive cells and loose packing of collagen I. These results indicate that the modulation of the fibrosis mediated by TGFß signalling contributes to enhancing the differentiation of cartilage and muscle during limited ear-hole regeneration.

"We have this, with my husband, we live in harmony": exploring the gendered decision-making matrix for malaria prevention and treatment in Nampula Province, Mozambique.

BACKGROUND: Conceptualizing gender dynamics and ways of bridging entrenched gender roles will contribute to better health promotion, policy and planning. Such processes are explored in relation to malaria in Mozambique. METHODS: A multi-method, qualitative study using focus group discussions (FGDs) and in-depth interviews (IDIs) explored the perspectives of community members, leaders and stakeholders on malaria. The study was conducted in Nampula Province, in an intervention district for the Tchova Tchova Stop Malaria (TTSM) gender-sensitive community dialogues, and in a non-intervention district. RESULTS: Participants (n = 106) took part in six FGDs and five IDIs in each district. Those exposed to TTSM commonly stated that the programme influenced more equalitarian gender roles, attitudes and uptake of protective malaria-related practices. These positive changes occurred within the context of an observed, gendered decision-making matrix, which aligns inward- or outward-facing decisions with malaria prevention or treatment. Decisions more dependent on male or elder sanctioning at community level are outward-facing decisions, while decisions falling within women's domain at household level are inward-facing decisions. Related to prevention, using bed nets was largely an inward-facing prevention decision for women, who were generally tasked with hanging, washing and making nets usable. Net purchase and appropriation for malaria prevention (rather than for instance for fishing) was men's prerogative. Regular net use was associated with sleeping together more regularly, bringing couples closer. Attending antenatal care to access intermittent preventive treatment during pregnancy was often an outward-facing prevention decision, under the purview of older, influential women and ultimately needing sanctioning by men. With respect to seeking care for malaria symptoms, women typically sought help from traditional healers first. This inward-facing treatment decision was within their control, in contrast to the frequently transport-dependent, outward-facing decision to attend a health facility. Sharing decisions was described as a feature of a "harmonious household," something that was said to be encouraged by the TTSM intervention and that was both lived and aspirational. CONCLUSIONS: TTSM community dialogues helped communication on both interpersonal (couple) and community levels, ultimately encouraging malaria-related behaviours. Leveraging ways of bringing men and women together to share decision making will improve malaria intervention success.

"We have this, with my husband, we live in harmony": exploring the gendered decision-making matrix for malaria prevention and treatment in Nampula Province, Mozambique

Background: Conceptualizing gender dynamics and ways of bridging entrenched gender roles will contribute to better health promotion, policy and planning. Such processes are explored in relation to malaria in Mozambique. Methods: A multi-method, qualitative study using focus group discussions (FGDs) and in-depth interviews (IDIs) explored the perspectives of community members, leaders and stakeholders on malaria. The study was conducted in Nampula Province, in an intervention district for the Tchova Tchova Stop Malaria (TTSM) gender-sensitive community dialogues, and in a non-intervention district. Results: Participants (n=106) took part in six FGDs and fve IDIs in each district. Those exposed to TTSM commonly stated that the programme infuenced more equalitarian gender roles, attitudes and uptake of protective malariarelated practices. These positive changes occurred within the context of an observed, gendered decision-making matrix, which aligns inward- or outward-facing decisions with malaria prevention or treatment. Decisions more dependent on male or elder sanctioning at community level are outward-facing decisions, while decisions falling within women's domain at household level are inward-facing decisions. Related to prevention, using bed nets was largely an inward-facing prevention decision for women, who were generally tasked with hanging, washing and mak ing nets usable. Net purchase and appropriation for malaria prevention (rather than for instance for fshing) was men's prerogative. Regular net use was associated with sleeping together more regularly, bringing couples closer. Attending antenatal care to access intermittent preventive treatment during pregnancy was often an outward-facing prevention decision, under the purview of older, infuential women and ultimately needing sanctioning by men. With respect to seeking care for malaria symptoms, women typically sought help from traditional healers frst. This inward-facing treatment decision was within their control, in contrast to the frequently transport-dependent, outward-facing decision to attend a health facility. Sharing decisions was described as a feature of a "harmonious household," something that was said to be encouraged by the TTSM intervention and that was both lived and aspirational.

Mechanisms of epithelial thickening due to IL-1 signalling blockade and TNF-α administration differ during wound repair and regeneration.

IL-1 and TNF-α are always present during wound repair, but their pleiotropic and synergistic effects are incompletely understood. In this work, we evaluated the role of IL-1 in wound repair, and examined whether TNF-α administration impaired scarless wound repair. First, we characterised wound repair in outbred CD-1 mice according to age and sex in an ear punch wound model. Then, we examined the effects of Interleukin 1 receptor antagonist (IL-1ra) and TNF-α placement inside ear wounds by means of loaded Heparin beads in young and middle-aged male and female mice. Wounds in middle-aged females repaired with scarless characteristics, whereas those in young males showed fibrotic scarring. Rather than improving wound repair in young males, IL-1 signalling blockade increased epithelial thickness and IL-1ß and TNF-α expression, and diminished epidermal apoptosis. TNF-α impaired wound repair in middle-aged females, which exhibited acanthosis and overexpression of IL-1, but no change in apoptosis. These findings suggest that this mechanism of epidermal thickening differs from that observed in IL1-ra-treated animals.

Association of Mass Media Communication with Contraceptive Use in Sub-Saharan Africa: A Meta-Analysis of Demographic and Health Surveys.

Literature abounds with evidence on the effectiveness of individual mass media interventions on contraceptive use and other health behaviors. There have been, however, very few studies summarizing effect sizes of mass media health communication campaigns in sub-Saharan Africa. In this study, we used meta-analytic techniques to pool data from 47 demographic and health surveys conducted between 2005 and 2015 in 31 sub-Saharan African countries and estimate the prevalence of exposure to family planning-related mass media communication. We also estimated the average effect size of exposure to mass media communication after adjusting for endogeneity. We performed meta-regression to assess the moderating role of selected variables on effect size. On average, 44% of women in sub-Saharan Africa were exposed to family planning-related mass media interventions in the year preceding the survey. Overall, exposure was associated with an effect size equivalent to an odds ratio of 1.93. More recent surveys demonstrated smaller effect sizes than earlier ones, while the effects were larger in lower contraceptive prevalence settings than in higher prevalence ones. The findings have implications for designing communication programs, setting expectations about communication impact, and guiding decisions about sample size estimation for mass media evaluation studies.

Use of SMS-Based Surveys in the Rapid Response to the Ebola Outbreak in Liberia: Opening Community Dialogue.

During an emerging health crisis like the 2014 Ebola outbreak in West Africa, communicating with communities to learn from them and to provide timely information can be a challenge. Insight into community thinking, however, is crucial for developing appropriate communication content and strategies and for monitoring the progress of the emergency response. In November 2014, the Health Communication Capacity Collaborative partnered with GeoPoll to implement a Short Message Service (SMS)-based survey that could create a link with affected communities and help guide the communication response to Ebola. The ideation metatheory of communication and behavior change guided the design of the survey questionnaire, which produced critical insights into trusted sources of information, knowledge of transmission modes, and perceived risks-all factors relevant to the design of an effective communication response that further catalyzed ongoing community actions. The use of GeoPoll's infrastructure for data collection proved a crucial source of almost-real-time data. It allowed for rapid data collection and processing under chaotic field conditions. Though not a replacement for standard survey methodologies, SMS surveys can provide quick answers within a larger research process to decide on immediate steps for communication strategies when the demand for speedy emergency response is high. They can also help frame additional research as the response evolves and overall monitor the pulse of the situation at any point in time.

A Theory-Based Socioecological Model of Communication and Behavior for the Containment of the Ebola Epidemic in Liberia.

The Ebola virus disease that emerged in the West African countries of Liberia, Sierra Leone, and Guinea in 2014 created an unprecedented public health emergency that caught national and international organizations off guard. Despite available guidelines to respond to public health emergencies, coordinated action to control the disease only came almost 6 months after what is now considered the first human contact with the virus. Theory-based frameworks, like the ideation model and the pathways framework, are important tools for guiding research and the design of communication activities and strategies to effectively impact on the more likely determinants of the intended behavior. By using theory, these frameworks increase the chances that localized research and communication interventions can effectively change desired behaviors and their behavioral determinants. In an outbreak situation such frameworks are all the more important, when time is of the essence and lives are on the line.

Voluntary medical male circumcision among adolescents: a missed opportunity for HIV behavioral interventions.

OBJECTIVE: Voluntary medical male circumcision (VMMC) is one of the first opportunities for adolescent males in African countries to interact with the healthcare system. This study explored the approaches used during adolescent VMMC counseling and whether these strategies maximize broader HIV prevention opportunities. METHODS: Qualitative interviews were conducted with 92 VMMC clients ages 10-19 years in South Africa (n = 36), Tanzania (n = 36), and Zimbabwe (n = 20) and 33 VMMC providers across the three countries. Discussions explored HIV prevention counseling, testing, and disclosure of results. Audio recordings were transcribed, translated into English, and coded thematically by two individuals. RESULTS: Male adolescents in all three countries reported that limited information was provided about HIV prevention and care, and adolescents were rarely provided condoms. Although VMMC protocols require opt-out HIV testing, adolescents recounted having blood taken without knowing the purpose, not receiving results, nor completely understanding the link between VMMC and HIV. Most males interviewed assumed they had tested negative because they were subsequently circumcised without knowing test results. Providers reported spending little time talking about HIV prevention, including condom use. They admitted that younger adolescent clients often receive little information if assumed they are not sexually active or too young to understand and instead discussed nonsexually transmitted routes of HIV. CONCLUSION: In the sites of the three countries studied, HIV prevention and care messages were inconsistent and sometimes totally absent from VMMC counseling sessions. VMMC appears to be a missed opportunity to engage in further HIV prevention and care with adolescents.

A Framework for Health Communication Across the HIV Treatment Continuum.

BACKGROUND: As test and treat rolls out, effective interventions are needed to address the determinants of outcomes across the HIV treatment continuum and ensure that people infected with HIV are promptly tested, initiate treatment early, adhere to treatment, and are virally suppressed. Communication approaches offer viable options for promoting relevant behaviors across the continuum. CONCEPTUAL FRAMEWORK: This article introduces a conceptual framework, which can guide the development of effective health communication interventions and activities that aim to impact behaviors across the HIV treatment continuum in low- and medium-income countries. The framework includes HIV testing and counseling, linkage to care, retention in pre-antiretroviral therapy and antiretroviral therapy initiation in one single-stage linkage to care and treatment, and adherence for viral suppression. The determinants of behaviors vary across the continuum and include both facilitators and barriers with communication interventions designed to focus on specific determinants presented in the model. At each stage, relevant determinants occur at the various levels of the social-ecological model: intrapersonal, interpersonal, health services, community, and policy. Effective health communication interventions have mainly relied on mHealth, interpersonal communication through service providers and peers, community support groups, and treatment supporters. DISCUSSION: The conceptual framework and evidence presented highlight areas across the continuum where health communication can significantly impact treatment outcomes to reach the 90-90-90 goals by strategically addressing key behavioral determinants. As test and treat rolls out, multifaceted health communication approaches will be critical.

Regarding realities: Using photo-based projective techniques to elicit normative and alternative discourses on gender, relationships, and sexuality in Mozambique.

This paper argues for the methodological merit of photo-based projective techniques (PT) in formative HIV communication research. We used this technique in Mozambique to study multiple sexual partnerships (MSPs) and the roles of social and gender norms in promoting or discouraging these behaviours. Facilitators used ambiguous photographs and vignettes to ease adult men and women into discussions of sexual risk behaviour and HIV transmission. Visuals upheld a third-person perspective in discussions, enabling participants to safely project their worldviews onto the photographed characters, and indirectly share their attitudes, normative environments, personal and peer experiences, perceived risks and benefits, and theories about motivations for extramarital sex. Visually grounded storylines contained rich detail about the circumstances and interpersonal conversations that contextualise MSP behaviour and norms. The research yielded findings about conflicting social practices of public encouragement and private disapproval. Despite concerns around the verifiability of PTs, the repetition and convergence in the elicited conversations - and confirmation through subsequent campaign design and evaluation - suggest these techniques can reliably elicit information for formative public health and communication research on psychosocial and normative factors.

Effectiveness of Community Dialogue in Changing Gender and Sexual Norms for HIV Prevention: Evaluation of the Tchova Tchova Program in Mozambique.

Structural HIV prevention interventions have gained prominence as ways to address underlying social and cultural factors that fuel the HIV epidemic. Identifying theories that explain how structural interventions are expected to change such factors can substantially increase their success. The Tchova Tchova community dialogue program, a theory-based intervention implemented in 2009-2010 in the provinces of Zambezia and Sofala, Mozambique, aimed to change gender and sexual norms for HIV prevention. Through facilitated sessions, the program sparked critical thinking and open dialogue among participants. This article measures the program's effectiveness based on a sample of 462 participants and 453 nonparticipants. The results show that the program was successful in producing changes in three of the underlying structural factors of HIV: gender attitudes, gender roles, and HIV stigma. The program was also successful in changing other factors associated with HIV infection, including HIV prevention knowledge, discussion of HIV between sex partners, and having multiple sex partners.

HIV Testing Among Young People Aged 16-24 in South Africa: Impact of Mass Media Communication Programs.

Knowing one's serostatus is critical in the HIV prevention, care and treatment continuum. This study examines the impact of communication programs on HIV testing in South Africa. Data came from 2204 young men and women aged 16-24 who reported to be sexually active in a population based survey. Structural equation modeling was used to test the directions and causal pathways between communication program exposure, HIV testing discussion, and having a test in the last 12 months. Bivariate and multivariate probit regressions provided evidence of exogeneity of communication exposure and the two HIV-related outcomes. One in three sampled individuals had been tested in the last 12 months. Communication program exposure only had an indirect effect on getting tested by encouraging young people to talk about testing. The study suggests that communication programs may create an environment that supports open HIV-related discussions and may have a long-term impact on behavior change.

HIV communication programs, condom use at sexual debut, and HIV infections averted in South Africa, 2005.

BACKGROUND: Since the 1990s, communication programs in South Africa have promoted HIV prevention, especially condom use. Although HIV prevalence stabilized after 2000, surveys have not clarified how prevention behavior contributed to that change. We present a secondary statistical analysis of the 2005 national South African Human Sciences Research Council survey that reveals how condom use at sexual debut-which normally occurs before infection from unprotected sex-may have contributed to the reduction in HIV infection. METHODS: Threats from measured and unobserved confounding variables are addressed through the use of several complementary statistical methods including structural equation modeling with multivariate probit regression and propensity score matching. The latter is used to create statistically comparable groups of those who used and did not use condoms at sexual debut to estimate the number of HIV infections averted attributed to this behavior. RESULTS: After controlling for 17 socioeconomic variables, awareness of HIV communication programs had a positive, dose-response relationship with self-reported condom use at sexual debut. Those who used condoms at sexual debut were 1.38 times more likely to have remained uninfected. HIV-negative status was 3.6 percentage points higher among those who used condoms at sexual debut, corresponding to an estimated 139,835 infections averted among sexually active adults by 2005. Never using injectable drugs and having 1 trusted partner also predicted HIV-negative status. CONCLUSIONS: We found a relationship between HIV communication awareness and condom use at sexual debut. Condom use at sexual debut, in turn, was associated with lower subsequent HIV risk.

Impacts of four communication programs on HIV testing behavior in South Africa.

This paper aims to evaluate the impacts of four communication programs on promoting HIV testing behavior among sexually active individuals in South Africa. The four programs, implemented by Johns Hopkins Health and Education in South Africa, are aimed to promote HIV prevention behaviors, as well as gender-based violence prevention, tuberculosis screening and treatment, and reduction of alcohol consumption. Launched between 2009 and 2010, they all promoted HIV testing. Data came from the population-based Third National AIDS Communication Survey 2012; 6004 men and women who had sex within the last 12 months were included in the analysis. Multiple causal attribution analysis is used to justify causal reference and estimate the impact of communication programs. Findings indicate significant direct and indirect effects of the programs on HIV testing behavior. Indirect effects worked through increasing one's likelihood of perceiving that their friends were tested and the probability of talking about HIV testing with sex partners and friends, which in turn increased the likelihood of HIV testing. Findings suggest multiple angles from which communication programs can promote HIV testing. The study also demonstrates the use of multiple statistical techniques for causal attribution in a post-only design, where randomization is not possible.

The effect of a joint communication campaign on multiple sex partners in Mozambique: the role of psychosocial/ideational factors.

Mozambique is one of the countries in sub-Saharan Africa most affected by the HIV epidemic. Multiple and concurrent sexual partnerships (MSP/CP) have been recognized as one of the key drivers in the rapid spread of HIV in the region. Though HIV prevention programs have been successful in increasing condom use and HIV testing, reducing the practice of MSP/CP has been more difficult. Grounding their interventions in social and behavior change theory, four organizations in Mozambique joined efforts to implement a year-long, multimedia national campaign for HIV prevention with emphasis on the reduction of MSP/CP. Evaluating its impact and identifying the factors that hinder or contribute to its success are critical to building effective programs in the future. With data from a 2011 population-based survey of 1427 sexually active women and men, multivariate causal attribution (MCA) analysis was used to estimate the impact of the campaign in the four regions of Mozambique with the highest levels of HIV prevalence. The analysis tested the psychosocial pathways through which the campaign was expected to affect MSP. The results indicate that exposure (recall) was high; 81.2% of the respondents could recall one or more of the communication campaign components. The campaign had a significant indirect impact on MSP through its negative effect on attitudes that favor MSP, and its positive effect on knowledge and discussion of MSP risk with sex partner. This study demonstrates the value of identifying appropriate psychosocial factors and using them to design the campaign communication strategy, and evaluate the causal pathways by which it has an impact. The campaign was successful in changing MSP behavior by working through two psychosocial variables.

Character recognition as an alternate measure of television exposure among children: findings from the Alam Simsim program in Egypt.

Evaluation of effects of mass media-based health interventions requires accurate assessments of exposure, which can be difficult to obtain when young children are the primary audience. Alam Simsim, the Egyptian version of Sesame Street, aired nationally in Egypt to teach preschoolers about numeracy, literacy, and gender-equitable attitudes. The purpose of this article was to assess the effect of the program through a first-of-its-kind household-level survey that interviewed caretakers (n = 426) and preschoolers (n = 486). The authors introduced and tested the efficacy of a parsimonious measure of exposure: children's recognition of the primary characters of the program. Overall, the authors' models explained as much as 53% of the variance in children's learning; exposure to the program was significantly associated with learning. Furthermore, the parsimonious measure of exposure was as effective as a more elaborate child-reported measure. Relative to these two measures of exposure, caretakers' report of children's viewing was not as good a predictor of learning.

Using health education theories to explain behavior change: a cross-country analysis. 2000-2001.

Scholars within the fields of public health, health education, health promotion, and health communication look to specific theories to explain health behavior change. The purpose of this article is to critically compare four health theories and key variables within them with regard to behavior change in the area of reproductive health. Using cross-country analyses of Ghana, Nepal, and Nicaragua (data sets provided by the Center for Communication Programs, Johns Hopkins University), the authors looked at the Health Belief Model, Theory of Reasoned Action, Extended Parallel Process Model, and Social Cognitive Theory for these two defined objectives. Results show that all four theories provide an excellent fit to the data, but that certain variables within them may have particular value for understanding specific aspects of behavior change. Recommendations for the selection of theories to use as guidelines in the design and evaluation of reproductive health programs are provided.

The psychosocial context of young adult sexual behavior in Nicaragua: looking through the gender lens.

CONTEXT: Understanding the nature and magnitude of gender differences in sexual norms among young adults in Nicaragua, and how these differences affect sexual behavior, is important for the design of reproductive health programs. METHODS: A representative cross-sectional survey was conducted in six departments in the Pacific region of Nicaragua in 1998. A total of 552 never-married women and 289 never-married men aged 15-24 were interviewed about their perceptions of social pressure to engage in premarital sex; perceived social approval of and attitudes toward premarital sex and premarital pregnancy; perceived sexual activity among peers and siblings; communication with parents on sexuality issues; the psychosocial context of sexual debut; and preferred sources of information on sexuality issues. RESULTS: Most young men (83%) reported that they had received direct encouragement from at least one person in the last year to engage in premarital sex, and at least half perceived that their father, siblings, other relatives and friends approved of premarital intercourse. A significantly greater proportion of men than of women reported that curiosity or gaining experience motivated their sexual debut (61% vs. 21%). Men perceived themselves to have a higher risk of unplanned and unprotected sex than did women. In contrast, women held more negative attitudes toward premarital sex and were more often discouraged by parents or siblings from engaging in sex. CONCLUSIONS: Reproductive health programs for young Nicaraguans need to address gender-based double standards, which raise the risk of unplanned, unprotected sex and unintended pregnancy.