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Evidence-Based Identification of Key Beliefs Explaining Infant Male Circumcision Motivation Among Expectant Parents in Zimbabwe: Targets for Behavior Change Messaging

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Abstract

Slow adult male circumcision uptake is one factor leading some to recommend increased priority for infant male circumcision (IMC) in sub-Saharan African countries. This research, guided by the integrated behavioral model (IBM), was carried out to identify key beliefs that best explain Zimbabwean parents’ motivation to have their infant sons circumcised. A quantitative survey, designed from qualitative elicitation study results, was administered to independent representative samples of 800 expectant mothers and 795 expectant fathers in two urban and two rural areas in Zimbabwe. Multiple regression analyses found IMC motivation among fathers was explained by instrumental attitude, descriptive norm and self-efficacy; while motivation among mothers was explained by instrumental attitude, injunctive norm, descriptive norm, self-efficacy, and perceived control. Regression analyses of beliefs underlying IBM constructs found some overlap but many differences in key beliefs explaining IMC motivation among mothers and fathers. We found differences in key beliefs among urban and rural parents. Urban fathers’ IMC motivation was explained best by behavioral beliefs, while rural fathers’ motivation was explained by both behavioral and efficacy beliefs. Urban mothers’ IMC motivation was explained primarily by behavioral and normative beliefs, while rural mothers’ motivation was explained mostly by behavioral beliefs. The key beliefs we identified should serve as targets for developing messages to improve demand and maximize parent uptake as IMC programs are rolled out. These targets need to be different among urban and rural expectant mothers and fathers.

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Acknowledgements

The research reported in this publication was supported by the National Institute of Mental Health of the National Institutes of Health under Award Number R01MH083594. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. We would like to acknowledge the study participants and the University of Zimbabwe, Department of Community Medicine ZiCHIRe Program study team for their enthusiastic participation in all phases of this study.

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Authors and Affiliations

  1. Department of Family and Child Nursing, School of Nursing, University of Washington, Box 357262, Seattle, WA, 98195-7920, USA

    Daniel E. Montaño & Danuta Kasprzyk

  2. Department of Global Health, University of Washington, Seattle, WA, USA

    Daniel E. Montaño & Danuta Kasprzyk

  3. Department of Community Medicine, University of Zimbabwe, Harare, Zimbabwe

    Mufuta Tshimanga

  4. Center for Studies in Demography and Ecology, University of Washington, Seattle, WA, USA

    Daniel E. Montaño, Deven T. Hamilton & Danuta Kasprzyk

  5. Department of Management and Marketing, The Hong Kong Polytechnic University, King’s Park, Hong Kong

    Gerald Gorn

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  1. Daniel E. Montaño
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Correspondence to Daniel E. Montaño.

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Conflict of interest

Daniel Montaño, Mufuta Tshimanga, Deven Hamilton, Gerald Gorn, and Danuta Kasprzyk each declares that he/she has no conflict of interest.

Ethical Approval

All procedures performed in this study involving human subjects were in accordance with the ethical standards of the US institutional IRB and the Medical Research Council of Zimbabwe, and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Written informed consent was obtained from all individual participants included in the study.

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Montaño, D.E., Tshimanga, M., Hamilton, D.T. et al. Evidence-Based Identification of Key Beliefs Explaining Infant Male Circumcision Motivation Among Expectant Parents in Zimbabwe: Targets for Behavior Change Messaging. AIDS Behav 22, 479–496 (2018). https://doi.org/10.1007/s10461-017-1796-4

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