Johns Hopkins Center for Communication Programs, Baltimore, Maryland.
Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Clin Infect Dis. 2018 Apr 3;66(suppl_3):S205-S212. doi: 10.1093/cid/cix971.
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.
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.
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.
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.
提供者的经验会影响青少年健康服务的质量，包括自愿男性包皮环切术（VMMC）。本研究考察了青少年 VMMC 服务中在职沟通和咨询的感知质量。
在南非、坦桑尼亚和津巴布韦的 14 个 VMMC 点进行了一项术后定量调查，测量总体满意度、舒适度、在职沟通和咨询的感知质量以及设施级别的感知质量。参与者为 10-14 岁（n=836）和 15-19 岁（n=457）的青少年男性客户，在 VMMC 后 7-10 天完成调查。使用多变量修正泊松回归和广义估计方程以及稳健方差估计，对与站点水平聚类相关的调整后流行率比（aPR）进行估计。
10-14 岁和 15-19 岁的儿童中，分别有 97.7%和 98.7%报告对他们的 VMMC 咨询体验表示满意或非常满意。大多数人也非常有可能（10-14 岁的 93.6%和 15-19 岁的 94.7%）或有些可能（10-14 岁的 66.6%和 15-19 岁的 52.6%）向同龄人推荐 VMMC。在 9 分制中，15-19 岁青少年的在职（咨询师）沟通感知质量中位数为 9（四分位距 [IQR]，8-9），10-14 岁青少年为 8（IQR，7-9）。10-14 岁的青少年比 15-19 岁的青少年更有可能认为在职（咨询师）沟通质量较低（评分<7；21.5%比 8.2%；aPR，1.61[95%置信区间，1.33-1.95]）。大多数青少年更喜欢男性咨询师和提供者，而不是女性。所有年龄段的青少年都希望更多地讨论世卫组织指导方针中概述的关键主题，如疼痛、伤口护理和愈合时间。
青少年认为在职沟通质量高，并向同龄人推荐 VMMC；然而，许多青少年希望更多地讨论世卫组织指导方针中概述的关键主题，如疼痛、伤口护理和愈合时间。
