Johns Hopkins Center for Communication Programs, Baltimore, Maryland.
Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
Clin Infect Dis. 2018 Apr 3;66(suppl_3):S189-S197. doi: 10.1093/cid/cix970.
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.
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.
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.
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.
在撒哈拉以南非洲，自愿男性包皮环切术（VMMC）是让男青少年参与医疗保健系统的为数不多的机会之一。关于青少年在 VMMC 过程中接受的父母沟通、参与和支持程度，数据有限。
我们在南非、坦桑尼亚和津巴布韦进行了 24 次焦点小组讨论，参与者为同意接受包皮环切或最近接受包皮环切的青少年的父母/监护人（N=192）。此外，我们还对南非（n=299）、坦桑尼亚（n=498）和津巴布韦（n=496）的 1293 名男青少年进行了 VMMC 体验访谈，这些青少年在手术后 7-10 天内接受了访谈。我们使用多变量泊松回归与广义估计方程和稳健标准误差来估计调整后的流行率比（aPR）。
父母/监护人指出，与儿子沟通 VMMC 时存在挑战和差距，尤其是当他们没有陪他们去诊所时。10-14 岁的青少年比 15-19 岁的青少年更有可能报告他们的父母陪他们参加术前咨询会议（56.5%比 12.5%；P<0.001）。在青少年中，年龄较小（aPR，0.86；95%置信区间[CI]，0.76-0.99）和农村环境（aPR，0.34；95%CI，0.13-0.89）不太可能与父母-青少年沟通障碍有关，而社会经济地位较低（aPR，1.37；95%CI，1.00-1.87）、不可知论（或非主要宗教信仰；aPR，2.87；95%CI，2.21-3.72）和居住在南非（aPR，2.63；95%CI，1.29-4.73）与父母对青少年 VMMC 沟通的感知障碍增加有关。父母/监护人发现，对于年龄较大的青少年，比年龄较小的青少年，他们在参与伤口护理方面更困难。
父母在 VMMC 体验中起着至关重要的作用，尤其是对年龄较小的男青少年而言。无论父母是否陪儿子去诊所，都需要制定策略，让他们在整个 VMMC 青少年体验中充分了解情况。
