PDF(Pubmed)
Abstract：
Primary healthcare facilities are central to the implementation of voluntary medical male circumcision (VMMC) as points of access to integrated health services in line with the Kenya AIDS Strategic Framework II (2020/21-2024/25). Knowledge of factors that explain men\'s uptake of VMMC and sexual health services at these facilities and preferences of where to get the services remain poorly understood. Using qualitative methodologies, we examined factors that determined facility choice for VMMC services and reasons for preferring the facility among men aged 25-39 years who previously underwent VMMC. The current study draws from focus group discussion interviews with circumcised men and their partners conducted as part of a randomized controlled trial to assess impact of two demand creation interventions in western Kenya. This involved 12 focus group discussions (FGD) with 6-10 participants each. Six FGDs were conducted with circumcised men, and 6 with their sex partners. Thematic issues relevant to a predetermined framework were identified. The themes were organized as follows: service availability, accessibility, affordability, appropriateness and, acceptability. Facility location, physical layout, organization of patient flow, infrastructure, and service provider skills were the outstanding factors affecting the choice of VMMC service outlets by men aged 25-39 years. Additionally, preferences were influenced by individual\'s disposition, attitudes, knowledge of VMMC services and tacit balance between their own recognized health needs versus desire to conform to social-cultural norms. Facility choice and individual preference are intricate issues, simultaneously involving multiple but largely intra-personal and facility-level factors. The intrapersonal dimensions elicited may also reflect differential responses to strategic communications and demand creation messages with promotion and prevention frames.
摘要：
初级卫生保健设施是实施自愿医疗男性包皮环切术（VMMC）的核心，作为根据肯尼亚艾滋病战略框架II（2020/21-2024/25）获得综合卫生服务的途径。对解释男性在这些设施中接受VMMC和性健康服务的因素的了解以及对在哪里获得服务的偏好仍然知之甚少。使用定性方法，我们研究了决定VMMC服务机构选择的因素,以及以前接受过VMMC的25~39岁男性中更喜欢该机构的原因.本研究来自对割礼男性及其伴侣的焦点小组讨论访谈，这是一项随机对照试验的一部分，目的是评估肯尼亚西部两种需求创造干预措施的影响。这涉及12个焦点小组讨论（FGD），每个6-10名参与者。六个FGD是对割礼的男人进行的，6和他们的性伴侣。确定了与预定框架相关的专题问题。主题组织如下：服务可用性，可访问性,负担能力，适当性和，可接受性。设施位置,物理布局，患者流动的组织，基础设施,和服务提供者技能是影响25-39岁男性选择VMMC服务网点的突出因素。此外,偏好受个人性格的影响，态度，对VMMC服务的了解以及他们自己公认的健康需求与符合社会文化规范的愿望之间的默契平衡。设施选择和个人偏好是复杂的问题，同时涉及多个但主要是个人内部和设施层面的因素。所引发的内部层面也可能反映出对战略沟通的不同反应，以及具有促进和预防框架的需求创造信息。
