SCALE-UP OF THE SAFE MALE CIRCUMCISIONCAMPAIGN
Pretest Report for The Hostel Video and Discussion Guide
(Kampala & Kayunga)
September 2011
Background
Health Communication Partnership (HCP) and the Ministry of Health are in the process of designing materials for scaling up Safe Male Circumcision (SMC) services in the country. The campaign will target adult males within the age bracket of 25-55 years in non-traditionally circumcising areas as well as women aged between 25-40years whose partners are uncircumcised. HCP contracted Fast Track Productions to help with developing the campaign materials. These include video episodes and discussion guides that will be used by peer educators in sensitizing young men and women aged 14-24 years on Safe Male Circumcision. Before finalizing the materials, a pretest exercise was undertaken to seek the views and input of the campaign’s target audiences on the developed materials.
Objectives of the pretest
The objectives of the pretest exercise were to:
- Establish whether peer educators can easily use the discussion guide.
- Find out whether community members can easily relate the video to SMCpractices being discussed.
- Determine whether the discussion guide relates to the video.
- Obtain feedback on the content in the discussion guide and the videoto help improve their use.
Methodology
The pretest exercise was carried out in the districts of Kayunga and Kampala using three complimentary methods i.e.
- In depth interviews (IDIs) with peer educators.
- Feedback sessions with participants of the discussion conducted by peer educators.
- Observation of peer educators as they use the discussion guide to facilitate group discussions on SMC
Four experienced peer educators (2 males and 2 females) were selected to conduct group sessions on SMC using the video and discussion guide. To ensure that each selected peer educator gets a chance to use the developed materials, the plan was to have each session co-facilitated by two peer educators. However in Kampala the group discussions were conducted by one peer educator owing to the fact that his counterpart was assigned other work related assignments on the day of the pretest. Nonetheless the pretest exercise was concluded successfully with two sessions being conducted in the two districts. Two research assistants (RAs) attended and observed each session, conducted feedback sessions with participants after attending the SMC group discussions and held in-depth interviews with facilitators. The research assistants completed a structured observation checklist during the group sessions. All the three peer educators were interviewed and one FGD was conducted in each district.
In preparation for the pretest exercise, research assistants were oriented about the study and introducedto the pretest tools.
Table 1: Description of FGDs
Kampala / Males aged 18-24 years / 1 / 12
Females aged 18-24 years / 1 / 12
Kayunga / Males aged 18-24 years / 1 / 12
Females aged 18-24 years / 1 / 12
Total / 4 / 48
Selection and Screening of FGD Respondents
The District Health Office and Makerere University Walter Reed Project mobilized the required respondents in Kampala and Kayunga respectively. FGD respondents were selected basing on the following characteristics:
- Uncircumcised males aged 18-24 years
- Females aged 18-24 years.
- Able to speak basicEnglish because the materials are in English.
- Should not be peer educators or health educators
Selection of Peer Educators to act as Facilitators
Mobilizers from the two youth centers in Kampala and Kayunga mobilized two peer educators to facilitate the discussions. The selected peer educators had the following characteristics.
Experience and confidence in conducting group discussions
Fluent in English.
The screening criteria were sent out to the mobilizers before identification of FGD respondents took place. In addition RAs rescreened the mobilized FGD respondents before start of the sessions.
Orientation of peer educators
The identified peer educatorswere oriented on SMC and how to use the video and discussion guide 3 days before the date of the pretest exercise in order to allow them time to familiarize themselves with the materials.
FGD venues
Mobilizers at the youth centers were tasked with identifying two venues for conducting the two FGDs in Kampala and Kayunga respectively. The venues were:
- Within the locality of where the FGD respondents live
- Devoid of interruptions like noise and people
- Private to allow people to express their opinions without fear
Pretest Findings
Observations:
The pre-test exercise sought to establish whether peer educators could easily use the discussion guide alongside The Hostel video. This objective was achieved by using the observation tool designed to capture the skills of the peer educators during the session and the following observations were made:
Peer educators were generally able to use the discussion guide alongside The Hostel video but moments of silence were experienced during discussions as facilitators repeatedly paused to read what was in the guide and then later explain to the participants.
Facilitators endeavored to refer to all pages of the guide although some information was not well explained especially where instructions required peer educators to engage the participants into pairs or small groups of 3-4 participants to role play their fears and concerns of SMC.
Follow-up questions that appear at the end of each topic were used by the peer educators but still some of the questions on small group discussions were not asked. This was indicative of the fact that facilitators did not understand the importance of these questions or did not prepare enough. However participants showed interest in all topics discussed as they were attentive throughout the sessions and asked many questions about SMC. (See appendix for FAQs about SMC). Majority of the questions that participants asked were about issues that were not discussed in the guide. This indicates that there is much more information about SMC that people would like to know that is not addressed in the discussion guide and video episodes. For example one respondent had this question to ask;
“You have said that SMC reduces the risk of HIV transmission by 60%, does this also apply for homosexuals or oral sex?”(Female respondent, Kampala).
Peer educators did not have ready answers to such questions but even for those that called for reference to the guide it was evident that locating information was difficult.
Peer educators in both Kampala and Kayunga seemed to be ill prepared to conduct the sessions. Their performance clearly showed that they had not read the discussionguide properly as a way preparing themselves for the sessions. They also seemed to lack sufficient knowledge about SMC.
The male peer educator in Kayungawas not fluent inenglish and failed to read sentences clearly.
Findings from FGDs:
The pretest also aimed at finding out whether participants could easily relate the video episodes to SMC practices. This objective was achieved by engaging one group of females and males in Kampala and Kayunga respectively who participated in the sessions ina focus group discussion immediately after the session facilitated by peer educators.
Views about the Sessions:
Asked to rate the sessions, all the participants mentioned that they were very educative and interesting. They added that the sessions were good because SMC was identified as one of the ways of preventing sexually transmitted infections and cancer of the cervix in women.
“The video addresses real life issues so it very good and I have found it interesting”(Female respondent).
Further they commented that they liked the sessions because they were watching the video episodes followed by questions which helped them to answer them. They indicated that if they watched the whole video and later ask questions, it would be difficult to remember anything. All participants commended the peer educators for the job well done and mentioned that the peer educators explained the basic facts about SMC very well. They also indicated that the discussion session was interesting, educative though it took longer than estimated.
However if the peer educators had been well prepared, all the sessions would have lasted the stipulated time. Moments of silence were experienced during discussions as peer educators repeatedly paused to read what was in the guide and then later explain to the participants. This element made the discussion more lengthy than planned.
Lessons learnt from the Sessions:
Participants mentioned that they had acquired a lot of information from the sessions. They mentioned that they learnt that;
- Safe Male Circumcision is carried out in hospitals or clinics with a where the surgical materials are sterile.
- Circumcision can only reduce the risk of HIV infection but is not an immunization against HIV.
- Circumcision improves someone’s hygiene
- The wound one gets after circumcision can be treated in less than a week provided one takes good care of it
- There is no pain during circumcision
- Sex after circumcision should be indulged in after six weeks when the wound has completely healed
- Condom use is vital even after circumcision.
- Safe Male Circumcision reduces the risk of contracting cancer of the cervix in women
- They should encourage their relatives and friends to go for SMC because it is cool.
- Circumcised men are gold medalists
- Circumcision is not as painful as it has been said to be
- Women prefer men who are circumcised.
Majority of the respondents said that peer educators explained clearly everything they talked about in the session. However more information was needed on how SMC prevents cervical cancer.
Specifically all respondents from Kampala and Kayungafound all the video episodes interesting and understandable.
They argued that the benefits of SMC were not demonstrated by Odoch in the video so that young men interested in becoming gold medalists can be encouraged. Therefore one of their recommendations was to have Odoch practicing the benefits of SMC.
Attitude towards SMC after the session:
Respondents expressed a positive attitude towards SMC after the session. Male respondents in Kayunga said the video helped them realize that the biases they had heard about SMC were wrong and baseless. Some stopped viewing SMC as the government’s ploy to Islamize the whole nation, others felt like getting circumcised and asked for how they can easily access the services. One male respondent was even willing to be circumcised immediately after the session
“At the end of this session, If you have come with the surgical materials, I will be willing to get circumcised” (Male respondent, Kayunga).
All respondents said that they would recommend their friends and relatives to attend similar sessions because they are educative and informative. Female respondents from Kampala added that they would specifically use the information they had acquired during the session to “sweet talk” their boyfriendsto get circumcised since they were now equipped with answers to the questions they always feared they would ask.
“I have two boyfriends, one who is circumcised and the other who is not. I think I am going to settle with the circumcised one”,(Female respondent Kampala).
“Though I don’t have a brother, I am going to convince my friends and relatives based on these facts about the benefits of Safe Male Circumcision”(Female participant Kampala)
All respondents expressed concerns about the availability of SMC services that many young men would want to get circumcised but the services are not widely available.
Findings from Peer Educators
In-depth interviews were held with each of the peer educators after completing their respective group discussions in order to solicit their views and feedback about The Hostel video, discussion guide and the sessions themselves.
Preparation for the Sessions:
Peer educators in both Kampala and Kayunga mentioned that they did not take time to read the discussion guide as part of their preparation for the sessions partly because the time between the training and the pretest exercise was too short to master the content very well.However they stressed that the information in the discussion guide was adequate enough to explain most of the issues around SMC. They further said that the video was a good tool which would help the youth to visualize what was is being discussed in the guide and in turn be in position to answer questions at the end of each episode.
Conducting the Sessions:
Asked whether it was easy for them to conduct the sessions, peer educators mentioned that the sessions were easy because they had done similar work before at their respective youth centers. They added that the only difference that existed between The Hostel sessions and those that they usually hold was that in the former, a discussion guide was included to help peer educators understand how to use the video to facilitate SMC discussions. One peer educator from Kayunga noted that the sessions were also a learning platform for her.
“I have been watching these episodes on NTV but had not taken serious interest in this topic. Using the discussion guide and video is a good opportunity for me to learn more about SMC. I find it very educative and let me hope that the campaign is going to be successful” (Female Peer Educator)
However peer educators expressed concern about the lack of sufficient reference materials especially for the questions not covered by the discussion guide. One of the questions asked by respondents in Kampala was what percentage SMC reduces the risk of HIV transmission in men who have sex with men. They indicated that they lacked statistical information to back-up their response to this question.
Suggestions for improving the Video and the Discussion Guide:
To improve on the two materials, peer educatorsfrom Kampala suggested that information about the sites offering SMC services should be included in the discussion guide. This will help peer educators refer young men who want to get circumcised for services.
The peer educators in Kayunga also suggested that the discussion guide should be shortened so that it can be easily used as a reference material. In its current form, the discussion guide was considered to have many pages and it would be difficult and time consuming for the peer educator to flip through all the pages while conducting a session.
Activities that require participants to split into smaller groups were found to be time consuming especially in a clinic setting where clients have come to access other services. The proposal is to reduce on the number of such activities.
The message that “you do not feel any pain at all” was dismissed by peer educators in Kayunga and proposed that it should be changed to read that there is ‘bearablepain’.
Peer educators in Kayunga proposed that the video clips should be merged into two major sessions i.e. one clip that addresses pre circumcision and the other that focuses on post circumcision. To them this would save on the time spent in the discussions.
Also as a way of improving the video, Odoch should be able to demonstrate or talk about the benefits of having been circumcised as a way of motivating fellow men to get circumcision. He should be able to share his own experience after being circumcised.
Conclusion:
Overall The Hostel video and discussion guide were well received and appreciated by the peer educators and young people who participated in the group discussions. The pretest objectives were achieved although all the peer educators did not find it easy to use the discussion guide alongside the video. There is need for peer educators to be oriented on how to effectively use the discussion guide alongside the video before they start using the two materials. The orientation workshop should last at least a full day so that peer educators are able to role play and practice use of the materials. For peer educators without background knowledge on SMC and how it reduces the risk of HIV transmission, one extra day would be needed to under the subject. A booklet with more information on SMC needs to be given to peer educators as a reference material.
Frequently Asked Questions (FAQs) about SMC during the Pretest Exercise.
- At what age should someone go for circumcision?
- What are the side effects of circumcision?
- Can circumcision cause impotence?
- Is circumcision done free of charge or there is a fee to be paid?
- Is circumcision not against God’s plan for humanity since God seems to have created the foreskin for a reason?
- Should people who are already HIV positive be circumcised?
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Scale-up of Safe Male Circumcision Campaign-SMC Pretest report Kampala and Kayunga District-September 2011