Perceived Quality of In-Service Communication and Counseling among Adolescents Undergoing Voluntary Medical Male Circumcision

Lynn M. Van Lith, Elizabeth C. Mallalieu, Eshan U. Patel, Kim H. Dam, Michelle R. Kaufman, Karin Hatzold, Arik V. Marcell, Webster Mavhu, Catherine Kahabuka, Lusanda Mahlasela, Emmanuel Njeuhmeli, Kim Seifert Ahanda, Getrude Ncube, Gissenge Lija, Collen Bonnecwe, Aaron A.R. Tobian

Research output: Contribution to journalArticlepeer-review

4 Scopus citations


Background. Experience with providers shapes the quality of adolescent health services, including voluntary medical male circumcision (VMMC). This study examined the perceived quality of in-service communication and counseling during adolescent VMMC services. Methods. A postprocedure quantitative survey measuring overall satisfaction, comfort, perceived quality of in-service communication and counseling, and perceived quality of facility-level factors was administered across 14 VMMC sites in South Africa, Tanzania, and Zimbabwe. Participants were adolescent male clients aged 10-14 years (n = 836) and 15-19 years (n = 457) and completed the survey 7 to 10 days following VMMC. Adjusted prevalence ratios (aPRs) were estimated by multivariable modified Poisson regression with generalized estimating equations and robust variance estimation to account for site-level clustering. Results. Of 10- to 14-year-olds and 15- to 19-year-olds, 97.7% and 98.7%, respectively, reported they were either satisfied or very satisfied with their VMMC counseling experience. Most were also very likely or somewhat likely (93.6% of 10- to 14-year olds and 94.7% of 15- to 19-year olds) to recommend VMMC to their peers. On a 9-point scale, the median perceived quality of in-service (counselor) communication was 9 (interquartile range [IQR], 8-9) among 15- to 19-year-olds and 8 (IQR, 7-9) among 10- to 14-year-olds. The 10- to 14-year-olds were more likely than 15- to 19-year-olds to perceive a lower quality of in-service (counselor) communication (score <7; 21.5% vs. 8.2%; aPR, 1.61 [95% confidence interval, 1.33-1.95]). Most adolescents were more comfortable with a male rather than female counselor and provider. Adolescents of all ages wanted more discussion about pain, wound care, and healing time. Conclusions. Adolescents perceive the quality of in-service communication as high and recommend VMMC to their peers; however, many adolescents desire more discussion about key topics outlined in World Health Organization guidance.

Original languageEnglish (US)
Pages (from-to)S205-S212
JournalClinical Infectious Diseases
StatePublished - Apr 3 2018


  • adolescents
  • counseling
  • in-service communication
  • sub-Saharan Africa
  • voluntary medical male circumcision

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases


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