College of Health Sciences, School of Nursing and Public Health, University of KwaZulu-Natal.
S Afr Fam Pract (2004). 2021 Nov 16;63(1):e1-e9. doi: 10.4102/safp.v63i1.5346.
KwaZulu-Natal (KZN) remains the epicentre of the human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) epidemic in South Africa. The incidence of HIV infection in KZN necessitates cost-effective strategies to curb the spread of infection. Voluntary medical male circumcision (VMMC) has been adopted as an additional biomedical preventive strategy since 2010 in line with recommendations from the World Health Organization. Despite several attempts to scale-up VMMC to reach age specific targets to achieve immediate aversion of infections, the uptake of VMMC remains sub-optimal, particularly in KZN. The purpose of this study is to describe the processes that were followed in developing, describing and evaluating an explanatory model for VMMC in KZN, South Africa.
A qualitative theory-generative phenomenographic study design was used to analyse the qualitative differences in primary healthcare stakeholders' experiences, understanding and conceptions of VMMC in KZN, South Africa. The emerging results informed the development of the VMMC explanatory model for KZN, South Africa. The model development process followed four steps, namely (1) concept analysis, (2) construction of relational statements, (3) model description and (4) model evaluation. The criteria of relevance for the target audience - applicability, clarity, user friendliness and originality of work - were used to evaluate the model.
The model's central premise is that the decision to undergo VMMC is shaped by a complex interplay of factors in the context or external environment of males (the extrinsic variable), which influences specific experiences, conceptions and understanding regarding VMMC (the influential/intrinsic variables). These collectively determine men's responses to VMMC (the outcome variable).
The model describes the process by which contextual, extrinsic and intrinsic variables interact to determine an individual male's response to VMMC, thus providing a guide to primary healthcare providers on care, practice and policy interventions to support the uptake of VMMC in the rural primary healthcare context of KZN, South Africa.
夸祖鲁-纳塔尔省（KZN）仍然是南非艾滋病毒/获得性免疫缺陷综合征（HIV/AIDS）疫情的中心。KZN 的艾滋病毒感染发病率需要采取具有成本效益的策略来遏制感染的传播。自 2010 年以来，自愿男性包皮环切术（VMMC）已被作为额外的生物医学预防策略采用，这符合世界卫生组织的建议。尽管为了达到特定年龄目标以实现即时感染规避，多次尝试扩大 VMMC 规模，但 VMMC 的普及率仍然不理想，特别是在 KZN。本研究的目的是描述在南非夸祖鲁-纳塔尔省开发、描述和评估 VMMC 解释模型的过程。
采用定性理论生成现象学研究设计，分析南非夸祖鲁-纳塔尔省初级保健利益相关者对 VMMC 的经验、理解和概念的定性差异。新出现的结果为开发南非夸祖鲁-纳塔尔省 VMMC 解释模型提供了信息。模型开发过程遵循四个步骤，即（1）概念分析，（2）关系陈述的构建，（3）模型描述和（4）模型评估。模型评估使用目标受众的相关性标准 - 适用性、清晰度、用户友好性和工作的原创性。
该模型的核心前提是，男性所处环境或外部环境（外在变量）中因素的复杂相互作用决定了接受 VMMC 的决定，这影响了男性对 VMMC 的具体体验、观念和理解（影响/内在变量）。这些因素共同决定了男性对 VMMC 的反应（结果变量）。
该模型描述了外在和内在变量相互作用决定个体男性对 VMMC 的反应的过程，为初级保健提供者提供了指南，以支持南非夸祖鲁-纳塔尔省农村初级保健环境中 VMMC 的采用，包括护理、实践和政策干预措施。
