Provider attitudes towards a brief behavioral intervention for sexual health in Moldova.

BACKGROUND: Brief behavioral interventions are seen as an efficient way to improve knowledge, change behavior, and reduce provider stigma regarding sexual health. When grounded in evidence-based behavioral change techniques and delivered using Brief Sexuality-related Communication (BSC) tools, brief behavioral interventions can address client-driven sexual health goals in a single session with their provider. Evidence for the efficacy of brief interventions for creating gains in sexual health comes largely from resource rich settings, and there is a lack of knowledge of how brief interventions can be implemented in the more resource constrained environments of low- and middle-income countries. As a first step in developing a brief intervention to address sexual health issues in Moldova, this paper reports on qualitative data collected from Moldovan providers to understand their attitudes, willingness and perceived barriers to the brief intervention and its implementation. METHODS: Thirty-nine in-depth interviews (IDI) were conducted between February and March 2020, with health providers recruited from three primary health care institutions, two Youth Friendly Health Centers and counselors from three NGOs who work with key populations in Moldova, including health centers selected from two cites - the capital city, Chisinau and from the Comrat Region. The IDI addressed four domains of provider attitudes: 1) attitudes towards the intervention; 2) willingness and motivation to implement the intervention; 3) logistics of providing the intervention and 4) ability to implement the intervention. A coding analysis approach was applied to all interview transcripts. RESULTS: Providers largely reported being willing to be trained in and implement the brief intervention. Willingness to implement the intervention stemmed from two perceptions: that it would improve the ability of providers to talk with their clients about sex, and that vulnerable groups would benefit from these conversations. However, while there were generally positive attitudes towards the intervention, providers consistently reported structural barriers to their perceived ability to implement the intervention. CONCLUSIONS: While providers reported high levels of initial acceptance of a brief behavioral intervention, care is needed to ensure that brief interventions, and the training of providers on brief interventions, incorporate cultural attitudes and norms around sex, particularly in highly patriarchal settings, and provide opportunities for providers to practice the intervention in ways that address their assumptions and implicit biases.

Experiențele adverse din copilărie și comportamentele asociate de risc pentru sănătate la studenţii din instituţiile de învăţământ superior din Republica Moldova

Studiul privind experien ele adverse din copilarie (EAC) a fost realizat pe un e antion de 1.534de studen i, cu vârstele cuprinse între 18  i 27 ani, înmatricula i în 14 institu ii de înva amântsuperior din Republica Moldova. Studen ii au completat un chestionar auto-raportat privindexpunerea la EAC, atât în aspect de maltratare a copilului, cât  i de disfunc ionalita i la nivel defamilie, în primii 18 ani de via a. Studiul demonstreaza ca pâna la împlinirea vârstei de 18 ani,majoritatea responden ilor (59,6%) s-ar fi confruntat cu unul sau mai multe episoade de EAC,iar 12,5% au raportat patru sau mai multe astfel de episoade. Cele mai frecvent raportate tipuride EAC au fost disciplinarea fizica (20,2%), abuzul emo ional (15,1%)  i neglijarea emo ionala(13%). Tipurile predominante de disfunc ii la nivel de familie au reprezentat divor ul sausepararea parin ilor (19,5%), prezen a unui membru al familiei cu probleme de abuz de alcool(14,9%)  i tratarea violenta a mamei în prezen a copilului (13,1%). A fost determinat un grad înalt de corelare între expunerea la EAC  i adoptarea unor comportamente de risc  i problemelor de sanatate. Riscul autovatamarii, consumul de alcool sau substan e psihotrope  i fumatul este considerabil mai mare la studen ii cu patru sau mai multe EAC. Studiul sugereaza necesitatea instituirii unor ac iuni intersectoriale pentru prevenirea maltratarii copiilor sau a altor EAC.

Adverse childhood experiences and health-risk behaviours in university students from the Republic of Moldova

This survey of adverse childhood experiences (ACEs) was undertaken with 1534 university students aged 18–27 years from 14 universities in the Republic of Moldova. Students completed a self-report questionnaire on whether they had experienced ACEs, defined as both child maltreatment and household dysfunction, during the first 18 years of their life. The study shows that most respondents (59.6%) encountered one or more ACEs during the first 18 years and 12.5% reported four or more.

The most frequently reported types of negative childhood events were corporal punishment (20.2%), emotional abuse (15.1%) and emotional neglect (13%). The most prevalent types of household dysfunction identified were in the form of parental divorce or separation (19.5%), the presence of a family member who abused alcohol (14.9%) and witnessing the mother being treated violently (13.1%).

The association between experiencing ACEs and adopting risky health behaviours was strong. The risks of self-harm, drug and alcohol use, and smoking increased substantially in students with four or more ACEs. The study suggests there is a need for intersectoral action to prevent child maltreatment and other ACEs from occurring.