Factors Associated with Parental Non-Adoption of Infant Male Circumcision for HIV Prevention in Sub-Saharan Africa: A Systematic Review and Thematic Synthesis

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Abstract

Infant male circumcision (IMC) may be more effective at preventing HIV than adult male circumcision as the procedure is carried out before the individual becomes sexually active. Successful scale-up will depend on identifying and overcoming parental concerns that may act as barriers for IMC. We conducted a systematic review to identify qualitative studies reporting on parental reasons for non-adoption of IMC for HIV prevention in sub-Saharan Africa. Thematic synthesis was subsequently conducted. Five descriptive themes were identified; these were later condensed into two main analytical themes: “poor knowledge” and “social constructs”. While barriers and motivators are to some degree context specific, this review suggests that there are common themes that need to be addressed across the region if uptake of IMC for HIV prevention is to be widely adopted. Study findings are therefore likely to have broad implications for IMC roll out.

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Resumen

Circuncisión infantil (IMC) puede ser más eficaz en la prevención del VIH que MC adultos como el procedimiento se lleva a cabo antes de que el individuo llega a ser sexualmente activo. Escalado exitosa dependerá de identificar y superar las preocupaciones parentales que pueden actuar como barreras para IMC. Se realizó una revisión sistemática para identificar estudios cualitativos informando sobre las razones de los padres para la no adopción de IMC para la prevención del VIH en África subsahariana. Posteriormente se realizó la síntesis temática. Se identificaron cinco temas descriptivos; Éstos fueron posteriormente condensadas en dos temas principales de análisis: “pobre conocimiento” y “construcciones sociales”. Mientras que las barreras y motivadores son poco grado de contexto específico, esta revisión sugiere que existen temas comunes que deben abordarse en toda la región si la absorción de IMC para la prevención del VIH va a ser ampliamente adoptado. Resultados del estudio por lo tanto, son propensos a tener amplias implicaciones para despliegue IMC.

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The online version of this article (doi:10.1007/s10461-014-0835-7) contains supplementary material, which is available to authorized users.

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Methods for the thematic synthesis of qualitative research in systematic reviews

James Thomas, Angela Harden (2008)

Background There is a growing recognition of the value of synthesising qualitative research in the evidence base in order to facilitate effective and appropriate health care. In response to this, methods for undertaking these syntheses are currently being developed. Thematic analysis is a method that is often used to analyse data in primary qualitative research. This paper reports on the use of this type of analysis in systematic reviews to bring together and integrate the findings of multiple qualitative studies. Methods We describe thematic synthesis, outline several steps for its conduct and illustrate the process and outcome of this approach using a completed review of health promotion research. Thematic synthesis has three stages: the coding of text 'line-by-line'; the development of 'descriptive themes'; and the generation of 'analytical themes'. While the development of descriptive themes remains 'close' to the primary studies, the analytical themes represent a stage of interpretation whereby the reviewers 'go beyond' the primary studies and generate new interpretive constructs, explanations or hypotheses. The use of computer software can facilitate this method of synthesis; detailed guidance is given on how this can be achieved. Results We used thematic synthesis to combine the studies of children's views and identified key themes to explore in the intervention studies. Most interventions were based in school and often combined learning about health benefits with 'hands-on' experience. The studies of children's views suggested that fruit and vegetables should be treated in different ways, and that messages should not focus on health warnings. Interventions that were in line with these suggestions tended to be more effective. Thematic synthesis enabled us to stay 'close' to the results of the primary studies, synthesising them in a transparent way, and facilitating the explicit production of new concepts and hypotheses. Conclusion We compare thematic synthesis to other methods for the synthesis of qualitative research, discussing issues of context and rigour. Thematic synthesis is presented as a tried and tested method that preserves an explicit and transparent link between conclusions and the text of primary studies; as such it preserves principles that have traditionally been important to systematic reviewing.

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Enhancing transparency in reporting the synthesis of qualitative research: ENTREQ

Sandy Oliver, Allison Tong, Kate Flemming … (2013)

Background The syntheses of multiple qualitative studies can pull together data across different contexts, generate new theoretical or conceptual models, identify research gaps, and provide evidence for the development, implementation and evaluation of health interventions. This study aims to develop a framework for reporting the synthesis of qualitative health research. Methods We conducted a comprehensive search for guidance and reviews relevant to the synthesis of qualitative research, methodology papers, and published syntheses of qualitative health research in MEDLINE, Embase, CINAHL and relevant organisational websites to May 2011. Initial items were generated inductively from guides to synthesizing qualitative health research. The preliminary checklist was piloted against forty published syntheses of qualitative research, purposively selected to capture a range of year of publication, methods and methodologies, and health topics. We removed items that were duplicated, impractical to assess, and rephrased items for clarity. Results The Enhancing transparency in reporting the synthesis of qualitative research (ENTREQ) statement consists of 21 items grouped into five main domains: introduction, methods and methodology, literature search and selection, appraisal, and synthesis of findings. Conclusions The ENTREQ statement can help researchers to report the stages most commonly associated with the synthesis of qualitative health research: searching and selecting qualitative research, quality appraisal, and methods for synthesising qualitative findings. The synthesis of qualitative research is an expanding and evolving methodological area and we would value feedback from all stakeholders for the continued development and extension of the ENTREQ statement.

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Methods for the synthesis of qualitative research: a critical review

Elaine Barnett-Page, James Thomas (2009)

Background In recent years, a growing number of methods for synthesising qualitative research have emerged, particularly in relation to health-related research. There is a need for both researchers and commissioners to be able to distinguish between these methods and to select which method is the most appropriate to their situation. Discussion A number of methodological and conceptual links between these methods were identified and explored, while contrasting epistemological positions explained differences in approaches to issues such as quality assessment and extent of iteration. Methods broadly fall into 'realist' or 'idealist' epistemologies, which partly accounts for these differences. Summary Methods for qualitative synthesis vary across a range of dimensions. Commissioners of qualitative syntheses might wish to consider the kind of product they want and select their method – or type of method – accordingly.

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Author and article information

Contributors

Webster Mavhu: +263 4 308042 , wmavhu@gmail.com

Journal

Journal ID (nlm-ta): AIDS Behav

Journal ID (iso-abbrev): AIDS Behav

Title: AIDS and Behavior

Publisher: Springer US (Boston )

ISSN (Print): 1090-7165

ISSN (Electronic): 1573-3254

Publication date (Electronic): 1 July 2014

Publication date PMC-release: 1 July 2014

Publication date (Print): 2014

Volume: 18

Pages: 1776-1784

Affiliations

[ ]Centre for Sexual Health and HIV/AIDS Research (CeSHHAR) Zimbabwe, 9 Monmouth Road, Avondale, Harare, Zimbabwe

[ ]Centre for Sexual Health and HIV Research, Research Department of Infection and Population Health, University College London, London, UK

Article

Publisher ID: 835

DOI: 10.1007/s10461-014-0835-7

PMC ID: 4125745

PubMed ID: 24980247

SO-VID: ba8afc26-635d-43fc-837f-eeada40f6671

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Open AccessThis article is distributed under the terms of the Creative Commons Attribution License which permits any use, distribution, and reproduction in any medium, provided the original author(s) and the source are credited.

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ScienceOpen disciplines: Infectious disease & Microbiology

Keywords: infant male circumcision,barriers,qualitative,interventions,sub-saharan africa

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ScienceOpen disciplines: Infectious disease & Microbiology

Keywords: infant male circumcision, barriers, qualitative, interventions, sub-saharan africa

Factors Associated with Parental Non-Adoption of Infant Male Circumcision for HIV Prevention in Sub-Saharan Africa: A Systematic Review and Thematic Synthesis

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Most cited references 59

Methods for the thematic synthesis of qualitative research in systematic reviews

Enhancing transparency in reporting the synthesis of qualitative research: ENTREQ

Methods for the synthesis of qualitative research: a critical review

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