How Informed are Clients Who Consent? A Mixed-Method Evaluation of Comprehension Among Clients of Male Circumcision Services in Zambia and Swaziland
Purchase on Springer.com
$39.95 / €34.95 / £29.95*
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.
Comprehension is fundamental for informed consent—an individual’s right to choose a medical procedure, such as male circumcision (MC). Because optimal benefits depend on post-surgical behaviors, comprehension is particularly critical for MC programs. We evaluated clients’ comprehension of MC’s risks and benefits, wound care instructions, and risk reduction post-MC using a true/false test (n = 1181) and 92 semi-structured interviews (SSIs) in Zambia and Swaziland. Most participants (89 % Zambia, 93 % Swaziland) passed the true/false test, although adolescents scored lower (significantly so in Swaziland) than adults and one-third (including nearly half of adolescents in Zambia) said MC has no risks. SSIs indicated confusion between “risk” of adverse surgical outcomes and reduced “risk” of HIV; most respondents acknowledged the 6 week abstinence period post-MC, yet few said resuming sex early increases HIV risk. Providers should distinguish between surgical “risks” and reduced HIV “risk,” and emphasize that HIV risk increases with sex before complete healing.
- Auvert B, Taljaard D, Lagarde E, Sobngwi-Tambekou J, Sitta R, Puern A. Randomized, controlled intervention trial of male circumcision for reduction of HIV infection risk: the ANRS 1265 trial. PLoS Med. 2005;2(11):e298:1112–22. CrossRef
- Bailey RC, Moses S, Parker CB, et al. Male circumcision for HIV prevention in young men in Kisumu, Kenya: a randomised controlled trial. Lancet. 2007;369:643–56. CrossRef
- Gray RH, Kigozi G, Serwadda D, et al. Male circumcision for HIV prevention in men in Rakai, Uganda: a randomised trial. Lancet. 2007;369:657–66. CrossRef
- World Health Organization/The Joint United Nations Programme on HIV/AIDS. New data on male circumcision and HIV prevention: policy and programme implications. Conclusions and recommendations of the WHO/UNAIDS technical consultation, March 6–8, Montreux, Switzerland. Geneva: WHO/UNAIDS; 2007.
- Joint United Nations Programme on HIV/AIDS. Global report: UNAIDS report on the global AIDS epidemic 2010. Geneva: UNAIDS; 2010.
- Swaziland Demographic and Health Survey 2006-07. Mbabane: Central Statistical Office (CSO) [Swaziland], and Macro International Inc; 2008.
- Zambia Demographic and Health Survey 2007. Calverton: Central Statistical Office (CSO), Ministry of Health (MOH), Tropical Diseases Research Centre (TDRC), University of Zambia, and Macro International Inc; 2009.
- World Health Organization/The Joint United Nations Programme on HIV/AIDS. Joint strategic action framework to scale-up voluntary medical male circumcision for HIV prevention in Eastern and Southern Africa, Geneva: WHO/UNAIDS; 2011. http://www.pepfar.gov/documents/organization/178294.pdf. Accessed 16 Feb 2012.
- Hallett TB, Alsallaq RA, Baeten JM, et al. Will circumcision provide even more protection from HIV to women and men? new estimates of the population impact of circumcision interventions. Sex Transm Infect. 2011;87(2):88–93. CrossRef
- Hallett TB, Singh K, Smith JA, White RG, Abu-Raddad LJ, Garnett GP. Understanding the impact of male circumcision interventions on the spread of HIV in southern Africa. PLoS ONE. 2008;3(5):e2212. CrossRef
- Londish GJ, Murray JM. Significant reduction in HIV prevalence according to male circumcision intervention in sub-Saharan Africa. Int J Epidemiol. 2008;37(6):1246–53. CrossRef
- UNAIDS. Safe, voluntary, informed male circumcision and comprehensive HIV prevention programming: guidance for decision-makers on human rights, ethical and legal considerations. Geneva: UNAIDS; 2008.
- Nuremberg Code. Trials of War Criminals before the Nuremberg Military Tribunals under Control Council Law No. 10. Nuremberg, October 1949–April 1949, Vol. 2, 181–182. Washington, DC: US Government Printing Office; 1949.
- World Medical Association (WMA). World Medical Association Declaration of Helsinki: Ethical Principles for Medical Research Involving Human Subjects. Helsinki: WMA; 1964.
- National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research (NCPHSBBR). The Belmont report: ethical principles and guidelines for the protection of human subjects of research. DHEW publication no. (OS) 78-0012. Washington, DC: US Government Printing Office; 1979.
- Council for International Organizations of Medical Sciences (CIOMS). International ethical guidelines for biomedical research involving human subjects. Geneva: WHO; 2002.
- Pierce Dennis B. The origin and nature of informed consent: experiences among vulnerable groups. J Prof Nurs. 1999;15:281–7. CrossRef
- Pine R, Wypijewska C. From consent to choice in family planning: application of an international framework to the United States. JAMWA. 2000;55:265–9.
- Berg JW, Appelbaum PS, Lidz CW, Parker LS. Informed consent: legal theory and clinical practice. New York: Oxford University Press; 2001.
- Cassell MM, Halperin DT, Shelton JD, Stanton D. Risk compensation: the Achilles’ heel of innovations in HIV prevention? BMJ. 2006;332(7541):605–7. CrossRef
- Eaton LA, Kalichman S. Risk compensation in HIV prevention: implications for vaccines, microbicides, and other biomedical HIV prevention technologies. Curr HIV/AIDS Rep. 2007;4(4):165–72. CrossRef
- Kalichman SC. Time to take stock in HIV/AIDS prevention. AIDS Behav. 2008;12(3):333–4. CrossRef
- Kalichman SC, Eaton L, Pinkerton SD. Male circumcision in HIV prevention. Lancet. 2007;369(9573):1597. author reply 1598-1599. CrossRef
- Mattson CL, Campbell RT, Bailey RC, Agot K, Ndinya-Achola JO, Moses S. Risk compensation is not associated with male circumcision in Kisumu, Kenya: a multi-faceted assessment of men enrolled in a randomized controlled trial. PLoS ONE. 2008;3(6):e2443. CrossRef
- Wawer MJ, Makumbi F, Kigozi G, et al. Circumcision in HIV-infected men and its effect on HIV transmission to female partners in Rakai, Uganda: a randomised controlled trial. Lancet. 2009;374(9685):229–37. CrossRef
- Gray RH, Kigozi G, Kong X, et al. The effectiveness of male circumcision for HIV prevention and effects on risk behaviors in a post-trial follow-up study. AIDS. 2012;26:609–15. CrossRef
- Mehta SD, Gray RH, Auvert B, et al. Does sex in the early period after circumcision increase HIV-seroconversion risk? pooled analysis of adult male circumcision clinical trials. AIDS. 2009;23(12):1557–64. CrossRef
- Hewett PC, Hallett TB, Mensch BS, et al. Sex with stitches: assessing the resumption of sexual activity during the postcircumcision wound-healing period. AIDS. 2012;26(6):749–56. CrossRef
- Herman-Roloff A, Bailey RC, Agot K. Factors associated with the early resumption of sexual activity following medical male circumcision in Nyanza Province, Kenya. AIDS Behav. 2012;16:1173–81. CrossRef
- White RG, Glynn JR, Orroth KK, et al. Male circumcision for HIV prevention in sub-Saharan Africa: who, what and when? AIDS. 2008;22(14):1841–50. CrossRef
- Ministry of Health (MOH). National Male circumcision strategy and implementation plan 2010-2020. Lusaka: WHO; 2010.
- Benatar S. Reflections and recommendations on research ethics in developing countries. Soc Sci Med. 2002;54:1131–41. CrossRef
- Fitzgerald D, Marotte C, Verdier R, Johnson WJ, Pape J. Comprehension during informed consent in a less-developed country. Lancet. 2002;360:1301–2. CrossRef
- Ulin PR, Robinson ET, Tolley EE. Qualitative methods in public health: a field guide for applied research. San Francisco: Family Health International and Jossey-Bass, Inc.; 2005.
- Glaser BG, Strauss AL. The discovery of grounded theory: strategies for qualitative research. New Brunswick: Transaction Publishers, Rutgers University; 1967.
- Green JM, Thorogood N. Qualitative Methods for Health Research. London: Sage Publications Ltd; 2004.
- Schenk KD, Williamson J. Ethical approaches to gathering information among children and adolescents in international settings: guidelines and resources. Washington, DC: Horizons/Population Council, Family Health International/IMPACT, US Agency for International Development (USAID); 2005.
- Cohn LD, Schydlower M, Foley J, Copeland RL. Adolescents’ misinterpretation of health risk probability expressions. Pediatrics. 1995;5:713–6.
- Reyna VF. How people make decisions that involve risk: a dual-process approach. Curr Dir Psychol Sci. 2004;13:60–6. CrossRef
- Ubel PA, Loewenstein G. The role of decision analysis in informed consent: choosing between intuition and systematicity. Soc Sci Med. 1997;44:647–56. CrossRef
- Peters E, Slovic P, Hibbard JH, Tusler M. Why worry? worry, risk perceptions and willingness to act to reduce medical errors. Health Psychol. 2006;25:144–52. CrossRef
- Peters E, Hibbard J, Slovic P, Dieckmann N. Numeracy skill and the communication, comprehension, and use of risk-benefit information. Health Aff. 2007;26(7):741–8. CrossRef
- Peters E. Numeracy and the perception and communication of risk. Ann NY Acad Sci. 2008;1128:1–7. CrossRef
- Peters E, Vastfjall D, Slovic P, et al. Numeracy and decision making. Psychol Sci. 2006;17:407–13. CrossRef
- Hawley ST, Zikmund-Fisher B, Ubel P, Jancovic A, Lucas T, Fagerlin A. The impact of the format of graphical presentation on health-related knowledge and treatment choices. Patient Educ Couns. 2008;73:448–55. CrossRef
- Lipkus IM, Samsa G, Rimer BK. General performance on a numeracy scale among highly educated samples. Med Decis Making. 2001;21:37–44. CrossRef
- Gigerenzer G, Edwards A. Simple tools for understanding risks: from innumeracy to insight. BMJ. 2003;327:741–4. CrossRef
- Waters EA, Weinstein ND, Colditz GA, Emmons K. Formats for improving risk communication in medical tradeoff decisions. J Health Commun. 2006;11:167–82. CrossRef
- Chua HF, Yates JF, Shah P. Risk avoidance: graphs versus numbers. Mem Cognit. 2006;34(2):399–410. CrossRef
- Peters E, Dieckmann N, Dixon A, Hibbard JH, Mertz CK. Less is more in presenting quality information to consumers. Med Care Res Rev. 2007;64(2):169–90. CrossRef
- How Informed are Clients Who Consent? A Mixed-Method Evaluation of Comprehension Among Clients of Male Circumcision Services in Zambia and Swaziland
AIDS and Behavior
Volume 17, Issue 6 , pp 2269-2282
- Cover Date
- Print ISSN
- Online ISSN
- Springer US
- Additional Links
- Male circumcision
- Informed consent
- Risk behavior
- VMMC programs
- Industry Sectors