Table 5.
Counseling Session Observations
| Sample Observation Items | Adolescents, No. (%) | ||
|---|---|---|---|
| Overall (n = 44)a |
Aged 10–14 y (n = 18) |
Aged 15–19 y (n = 23) |
|
| Provider introduction | |||
| Greets the adolescent | 41 (93.2) | 16 (88.9) | 22 (95.7) |
| Tells the adolescent his/her name | 41 (93.2) | 15 (83.3) | 23 (100.0) |
| Asks for the adolescent’s name | 32 (72.7) | 16 (88.9) | 14 (60.9) |
| Tells the adolescent he/she is going to ask some personal questions | 13 (29.5) | 1 (5.6) | 11 (47.8) |
| Reassures the adolescent all information provided will be kept confidential | 10 (22.7) | 2 (11.1) | 7 (30.4) |
| Ensures privacy in the counseling area | 26 (59.1) | 11 (61.1) | 14 (60.9) |
| Provider provided VMMC and HIV testing explanation | |||
| The benefits of VMMC | 44 (100.0) | 18 (100.0) | 23 (100.0) |
| The risks associated with the procedure | 28 (63.6) | 12 (66.7) | 15 (65.2) |
| The meaning of partial protection from HIV infection after VMMC | 41 (93.2) | 16 (88.9) | 22 (95.7) |
| The importance of HIV testing | 35 (79.5) | 13 (72.2) | 19 (82.6) |
| The adolescent is strongly urged to be tested for HIV but he may decline and still undergo the procedure | 29 (65.9) | 14 (77.8) | 14 (60.9) |
| The HIV test result will be shared with the adolescent | 35 (79.5) | 14 (77.8) | 18 (78.3) |
| Provider provided postprocedure care explanation | |||
| How much pain the adolescent could experience during the procedure | 38 (86.4) | 17 (94.4) | 20 (87.0) |
| How much pain the adolescent could experience after the procedure | 36 (81.8) | 16 (88.9) | 19 (82.6) |
| How to take care of the wound | 40 (90.9) | 18 (100.0) | 21 (91.3) |
| Why follow-up visits are needed | 41 (93.2) | 18 (100.0) | 20 (87.0) |
| How to look for specific complications (infection, bleeding, etc) | 29 (65.9) | 12 (66.7) | 15 (65.2) |
| What to do if complications arise | 33 (75.0) | 13 (72.2) | 18 (78.3) |
| The importance of abstaining from sex for at least 6 wk after the procedure | 19 (43.2) | 5 (27.8) | 13 (56.5) |
| The importance of abstaining from masturbation/self-sex for at least 6 wk | 16 (36.4) | 4 (22.2) | 11 (47.8) |
| The need to use condoms even after being circumcised | 23 (52.3) | 7 (38.9) | 15 (65.2) |
| How to use condoms (ie, condom demonstration) | 6 (13.6) | 0 | 5 (21.7) |
| The need to reduce the number of sexual partners even after circumcision | 14 (31.8) | 1 (5.6) | 12 (52.2) |
| Provider-adolescent communication | |||
| Asks questions to make sure the adolescent understands the information provided | 44 (100.0) | 18 (100.0) | 23 (100.0) |
| Asks the adolescent to ‘teach back’ what he just learned to the provider | 27 (61.4) | 13 (72.2) | 13 (56.5) |
| Provider response to adolescent feedback | |||
| Asks the adolescent if he has (any other) questions or needs clarification | 41 (93.2) | 18 (100.0) | 21 (91.3) |
| Allows the adolescent enough time to ask anything he wants | 41 (93.2) | 18 (100.0) | 21 (91.3) |
| Answers the adolescent’s questions in a relaxed manner without seeming rushed | 32 (72.7) | 11 (61.1) | 19 (82.6) |
| Provider uses age-appropriate speech | |||
| Avoids the use of medical jargon | 39 (88.6) | 16 (88.9) | 20 (87.0) |
| Asks if the adolescent has ever had sex | 10 (22.7) | 3 (16.7) | 7 (30.4) |
| Asks if the adolescent is sexually active | 9 (20.5) | 3 (16.7) | 6 (26.1) |
| Provider providing comfort | |||
| Reassures the adolescent by clarifying his concerns/doubts | 40 (90.9) | 18 (100.0) | 22 (95.7) |
| Tries to make the adolescent feel comfortable during the session | 40 (90.9) | 18 (100.0) | 22 (95.7) |
| Provider gives attention and respect | |||
| Shows/seems interested in what the adolescent has to say | 35 (79.5) | 14 (77.8) | 21 (91.3) |
| Shows respect for the opinion and decisions of the adolescent | 30 (68.2) | 12 (66.7) | 18 (78.3) |
| Uses body language that communicates paying full attention to the adolescent | 40 (90.9) | 18 (100.0) | 22 (95.7) |
| Treats the adolescent with respect during the entire counseling session | 44 (100.0) | 18 (100.0) | 23 (100.0) |
Abbreviations: HIV, human immunodeficiency virus; VMMC, voluntary medical male circumcision.
aAnalysis of observations by age category (10–14 vs 15–19 years) excluded observations where age was not indicated (n = 3).