Research and Evaluation
Under the Government of the Kingdom of Swaziland’s (GKOS) PEPFAR-funded Accelerated Saturation Initiative (ASI), male circumcision (MC) was provided in Swaziland nationally during 2011. Throughout the campaign, communications were strategic and targeted. Despite high awareness of Soka Uncobe, demand for services remained low. At the start of the program, the campaign used the PSI Trac (Tracking Results Continuously) 2010 study to understand behavior and inform messaging. As the campaign progressed, implementers identified the need to identify and document possible changes in attitudes and behaviors relating to MC.
In August 2011, Futures Group engaged partners, MOH and PEPFAR to design and implement a three-pronged research methodology to provide the program with an in-depth understanding of the perceptions around VMMC to better understand why men were not presenting for services, to inform the campaign. The methodology included both qualitative and quantitative data collection. First, interpersonal communications agents at PSI, tasked with interacting daily with the target audience, journaled their conversations for two weeks. Second, videoethnography conducted by trained interviewers at Matchboxology, captured 30+ hours of VMMC conversations, including fears, myths, barriers, and intention. Third, a quantitative survey, implemented by a local Swazi organization, informed by the two formative activities, was carried out among men and women in the target population to assess intention and identify gaps. This quantitative household survey was designed and conducted in November 2011 to assess knowledge, attitudes and practices (KAP) of local communities towards VMMC in Swaziland. Specifically, the survey aimed to:
- Evaluate the knowledge, attitudes and practices of the local communities on VMMC;
- Identify drivers and barriers to uptake of VMMC;
- Assess the effectiveness of the Soka Uncobe communications campaign; and
- Establish a baseline from which to measure the impact of the programme in subsequent years.
The Soka Uncobe team applied a two-stage randomized stratification sampling strategy covering all four regions of Swaziland (N=800). Questions covered demographics, brand awareness, access, VMMC behavior, knowledge, attitudes and perceptions.
Triangulated data of the three research activities provided insight into the barriers of uptake. Results from the quantitative survey showed that although there was a 91 percent awareness of circumcision, nationally, the largest barrier to circumcision was fear of pain. Other barriers included fear of something going wrong, and a general lack of understanding of the VMMC process. The initial campaign was oriented to address HIV Testing and Counseling (HTC) as a barrier, but this research found that HTC is not a barrier. The qualitative data found the same. Data were used to shift the ASI communication strategy to take into account these findings.
In addition to the behavior data generated before and during the project, JSI is responsible for a process evaluation of the Soka Uncobe campaign. This report is currently being drafted and will be available later in 2012 from JSI.