TY - JOUR
T1 - Parental Communication, Engagement, and Support during the Adolescent Voluntary Medical Male Circumcision Experience
AU - Dam, Kim H.
AU - Kaufman, Michelle R.
AU - Patel, Eshan U.
AU - Van Lith, Lynn M.
AU - Hatzold, Karin
AU - Marcell, Arik V.
AU - Mavhu, Webster
AU - Kahabuka, Catherine
AU - Mahlasela, Lusanda
AU - Njeuhmeli, Emmanuel
AU - Ahanda, Kim Seifert
AU - Ncube, Getrude
AU - Lija, Gissenge
AU - Bonnecwe, Collen
AU - Tobian, Aaron A.R.
N1 - Funding Information:
Financial support. This work was supported by USAID with PEPFAR funding (cooperative agreement number AID-OAA-A-12-00058) to the Johns Hopkins Center for Communication Programs, and co-funded by UK Department of International Development through the Integrated Support Program in Zimbabwe.
Publisher Copyright:
© 2018 The Author(s). Published by Oxford University Press for the Infectious Diseases Society of America.
PY - 2018/4/3
Y1 - 2018/4/3
N2 - Background. Voluntary medical male circumcision (VMMC) is one of few opportunities in sub-Saharan Africa to engage male adolescents in the healthcare system. Limited data are available on the level of parental communication, engagement, and support adolescents receive during the VMMC experience. Methods. We conducted 24 focus group discussions with parents/guardians of adolescents (N = 192) who agreed to be circumcised or were recently circumcised in South Africa, Tanzania, and Zimbabwe. In addition, male adolescents (N = 1293) in South Africa (n = 299), Tanzania (n = 498), and Zimbabwe (n = 496) were interviewed about their VMMC experience within 7-10 days postprocedure. We estimated adjusted prevalence ratios (aPRs) using multivariable Poisson regression with generalized estimating equations and robust standard errors. Results. Parents/guardians noted challenges and gaps in communicating with their sons about VMMC, especially when they did not accompany them to the clinic. Adolescents aged 10-14 years were significantly more likely than 15- to 19-year-olds to report that their parent accompanied them to a preprocedure counseling session (56.5% vs 12.5%; P <.001). Among adolescents, younger age (aPR, 0.86; 95% confidence interval [CI],.76-.99) and rural setting (aPR, 0.34; 95% CI,.13-.89) were less likely to be associated with parental-adolescent communication barriers, while lower socioeconomic status (aPR, 1.37; 95% CI, 1.00-1.87), being agnostic (or of a nondominant religion; aPR, 2.87; 95% CI, 2.21-3.72), and living in South Africa (aPR, 2.63; 95% CI, 1.29-4.73) were associated with greater perceived barriers to parental-adolescent communication about VMMC. Parents/guardians found it more difficult to be involved in wound care for older adolescents than for adolescents <15 years of age. Conclusions. Parents play a vital role in the VMMC experience, especially for younger male adolescents. Strategies are needed to inform parents completely throughout the VMMC adolescent experience, whether or not they accompany their sons to clinics.
AB - Background. Voluntary medical male circumcision (VMMC) is one of few opportunities in sub-Saharan Africa to engage male adolescents in the healthcare system. Limited data are available on the level of parental communication, engagement, and support adolescents receive during the VMMC experience. Methods. We conducted 24 focus group discussions with parents/guardians of adolescents (N = 192) who agreed to be circumcised or were recently circumcised in South Africa, Tanzania, and Zimbabwe. In addition, male adolescents (N = 1293) in South Africa (n = 299), Tanzania (n = 498), and Zimbabwe (n = 496) were interviewed about their VMMC experience within 7-10 days postprocedure. We estimated adjusted prevalence ratios (aPRs) using multivariable Poisson regression with generalized estimating equations and robust standard errors. Results. Parents/guardians noted challenges and gaps in communicating with their sons about VMMC, especially when they did not accompany them to the clinic. Adolescents aged 10-14 years were significantly more likely than 15- to 19-year-olds to report that their parent accompanied them to a preprocedure counseling session (56.5% vs 12.5%; P <.001). Among adolescents, younger age (aPR, 0.86; 95% confidence interval [CI],.76-.99) and rural setting (aPR, 0.34; 95% CI,.13-.89) were less likely to be associated with parental-adolescent communication barriers, while lower socioeconomic status (aPR, 1.37; 95% CI, 1.00-1.87), being agnostic (or of a nondominant religion; aPR, 2.87; 95% CI, 2.21-3.72), and living in South Africa (aPR, 2.63; 95% CI, 1.29-4.73) were associated with greater perceived barriers to parental-adolescent communication about VMMC. Parents/guardians found it more difficult to be involved in wound care for older adolescents than for adolescents <15 years of age. Conclusions. Parents play a vital role in the VMMC experience, especially for younger male adolescents. Strategies are needed to inform parents completely throughout the VMMC adolescent experience, whether or not they accompany their sons to clinics.
KW - HIV
KW - adolescents
KW - parents
KW - sub-Saharan Africa
KW - voluntary medical male circumcision
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U2 - 10.1093/cid/cix970
DO - 10.1093/cid/cix970
M3 - Article
C2 - 29617779
AN - SCOPUS:85045460651
SN - 1058-4838
VL - 66
SP - S189-S197
JO - Clinical Infectious Diseases
JF - Clinical Infectious Diseases
ER -