Perceived Quality of In-Service Communication and Counseling among Adolescents Undergoing Voluntary Medical Male Circumcision

Lynn M. Van Lith, Elizabeth C. Mallalieu, Eshan U. Patel, Kim H. Dam, Michelle Kaufman, Karin Hatzold, Arik V Marcell, Webster Mavhu, Catherine Kahabuka, Lusanda Mahlasela, Emmanuel Njeuhmeli, Kim Seifert Ahanda, Getrude Ncube, Gissenge Lija, Collen Bonnecwe, Aaron A Tobian

Research output: Contribution to journalArticle


Background. Experience with providers shapes the quality of adolescent health services, including voluntary medical male circumcision (VMMC). This study examined the perceived quality of in-service communication and counseling during adolescent VMMC services. Methods. A postprocedure quantitative survey measuring overall satisfaction, comfort, perceived quality of in-service communication and counseling, and perceived quality of facility-level factors was administered across 14 VMMC sites in South Africa, Tanzania, and Zimbabwe. Participants were adolescent male clients aged 10-14 years (n = 836) and 15-19 years (n = 457) and completed the survey 7 to 10 days following VMMC. Adjusted prevalence ratios (aPRs) were estimated by multivariable modified Poisson regression with generalized estimating equations and robust variance estimation to account for site-level clustering. Results. Of 10- to 14-year-olds and 15- to 19-year-olds, 97.7% and 98.7%, respectively, reported they were either satisfied or very satisfied with their VMMC counseling experience. Most were also very likely or somewhat likely (93.6% of 10- to 14-year olds and 94.7% of 15- to 19-year olds) to recommend VMMC to their peers. On a 9-point scale, the median perceived quality of in-service (counselor) communication was 9 (interquartile range [IQR], 8-9) among 15- to 19-year-olds and 8 (IQR, 7-9) among 10- to 14-year-olds. The 10- to 14-year-olds were more likely than 15- to 19-year-olds to perceive a lower quality of in-service (counselor) communication (score <7; 21.5% vs. 8.2%; aPR, 1.61 [95% confidence interval, 1.33-1.95]). Most adolescents were more comfortable with a male rather than female counselor and provider. Adolescents of all ages wanted more discussion about pain, wound care, and healing time. Conclusions. Adolescents perceive the quality of in-service communication as high and recommend VMMC to their peers; however, many adolescents desire more discussion about key topics outlined in World Health Organization guidance.

Original languageEnglish (US)
Pages (from-to)S205-S212
JournalClinical Infectious Diseases
Publication statusPublished - Apr 3 2018



  • adolescents
  • counseling
  • in-service communication
  • sub-Saharan Africa
  • voluntary medical male circumcision

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

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