title: Identification of Key Beliefs Explaining Male Circumcision Motivation Among Adolescent Boys in Zimbabwe: Targets for Behavior Change Communication.
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.
authors.affiliation: Department of Family & Child Nursing, University of Washington, Seattle, WA, USA. kasprzyk@uw.edu.|Department of Global Health, University of Washington, Seattle, WA, USA. kasprzyk@uw.edu.|Center for Studies in Demography and Ecology, University of Washington, Seattle, WA, USA. kasprzyk@uw.edu.|Department of Family and Child Nursing, School of Nursing, University of Washington, Box 357262, Seattle, WA, 98195-7262, USA. kasprzyk@uw.edu.
authors.forename: Danuta
authors.identifier: 0000-0002-3741-7761
authors.initials: D
authors.lastname: Kasprzyk
authors.affiliation: Department of Community Medicine, University of Zimbabwe, Harare, Zimbabwe.
authors.forename: Mufuta
authors.initials: M
authors.lastname: Tshimanga
authors.affiliation: Center for Studies in Demography and Ecology, University of Washington, Seattle, WA, USA.
authors.forename: Deven T
authors.initials: DT
authors.lastname: Hamilton
authors.affiliation: Department of Management and Marketing, The Hong Kong Polytechnic University, Hong Kong, Hong Kong.
authors.forename: Gerald J
authors.initials: GJ
authors.lastname: Gorn
authors.affiliation: Department of Family & Child Nursing, University of Washington, Seattle, WA, USA.|Department of Global Health, University of Washington, Seattle, WA, USA.|Center for Studies in Demography and Ecology, University of Washington, Seattle, WA, USA.
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Montaño
mesh_terms: D000293:Adolescent; D006801:Humans; D008297:Male; D002944:Circumcision, Male / Q000523:psychology / Q000706:statistics & numerical data; D003142:Communication; D007722:Health Knowledge, Attitudes, Practice; D015658:HIV Infections / Q000208:ethnology / Q000517:prevention & control / Q000635:transmission; D033182:Intention; D007407:Interviews as Topic; D009042:Motivation; D015995:Prevalence; D036301:Qualitative Research; D012424:Rural Population; D011795:Surveys and Questionnaires; D014505:Urban Population; D015030:Zimbabwe
keywords: Adolescent boys; Behavior change communication; Behavioral theory; Evidence based demand creation; Integrated Behavioral Model; Issues to focus communication campaigns; Voluntary medical male circumcision