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Lim RBT, Tham DKT, Cheung ON, Adaikan PG, Wong ML. A Public Health Communication Intervention Using Edutainment and Communication Technology to Promote Safer Sex among Heterosexual Men Patronizing Entertainment Establishments. JOURNAL OF HEALTH COMMUNICATION 2019; 24:47-64. [PMID: 30698082 DOI: 10.1080/10810730.2019.1572839] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
It is a challenge to reach out, develop and implement a communication intervention for heterosexual men (HSM) patronizing entertainment establishments (EEs) to promote safer sex. We described the theoretical basis and process from assessment to implementation where edutainment (talk shows) and communication technology (interactive web portal) was implemented. A female comedian hosted the talk shows. The portal contained an HIV risk profile calculator with individually tailored strategies to lower risk; two videos on real-life stories of unsafe sex and exit strategies to avoid casual or paid sex; as well as online support. We integrated edutainment, social cognitive theory (SCT) and the elaboration likelihood model (ELM). Edutainment techniques like humor through jokes, fun through games, and narrative persuasion through real-life accounts were applied. The SCT focused on modifying attitudes and social norm on sexual well-being, increasing self-perceived HIV/STI risk as well as building self-efficacy and skills in condom use. We applied the ELM to guide communication strategies and message development. For peripheral processing, we used cues like comedian delivery and charisma. For central processing, we focused on argument framing, issue involvement, argument quality, and modeling. The intervention was effective in promoting condom use with casual partners among the target group in Singapore.
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Affiliation(s)
- Raymond Boon Tar Lim
- a Health Systems & Behavioural Science, Saw Swee Hock School of Public Health , National University of Singapore , Singapore city , Singapore
| | - Dede Kam Tyng Tham
- a Health Systems & Behavioural Science, Saw Swee Hock School of Public Health , National University of Singapore , Singapore city , Singapore
| | - Olive Ny Cheung
- a Health Systems & Behavioural Science, Saw Swee Hock School of Public Health , National University of Singapore , Singapore city , Singapore
| | - P Ganesan Adaikan
- b Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine , National University of Singapore , Singapore city , Singapore
| | - Mee Lian Wong
- a Health Systems & Behavioural Science, Saw Swee Hock School of Public Health , National University of Singapore , Singapore city , Singapore
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Lim RBT, Cheung ONY, Tham DKT, La HH, Win TT, Chan R, Wong ML. Using qualitative and community-based engagement approaches to gain access and to develop a culturally appropriate STI prevention intervention for foreign female entertainment workers in Singapore. Global Health 2018; 14:36. [PMID: 29661249 PMCID: PMC5902891 DOI: 10.1186/s12992-018-0358-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 04/09/2018] [Indexed: 11/30/2022] Open
Abstract
Background There is an increasing global movement of foreign female entertainment workers (FEWs), a hard-to-reach population vulnerable to HIV/STIs. This paper described the needs assessment phase before intervention implementation where the socio-organisation, sexual risk behaviours and access to health services of foreign FEWs in Singapore were explored. We also highlighted how qualitative inquiry, census enumeration technique and community-based engagement approaches were used to gain access and to develop a culturally appropriate STI prevention intervention. Methods In-depth interviews, observations, informal conversational interviews, mystery client and critical incident technique were used. We estimated the size of FEW population using the census enumeration technique. The findings were used to inform intervention development and implementation. Results We estimated 376 Vietnamese and 330 Thai FEWs in 2 geographical sites where they operated in Singapore. Their reasons for non-condom use included misconceptions on the transmission and consequences of STI/HIV, low risk perception of contracting HIV/STI from paid/casual partner, lack of skills to negotiate or to persuade partner to use condom, unavailability of condoms in entertainment establishments and fear of the police using condom as circumstantial evidence. They faced difficulties in accessing health services due to fear of identity exposure, stigmatisation, cost and language differences. To develop the intervention, we involved FEWs and peer educators, and ensured that the intervention was non-stigmatising and met their needs. To foster their participation, we used culturally-responsive recruitment strategies, and ensured that the trial was anonymous and acceptable to the FEWs. These strategies were effective as we achieved a participation rate of 90.3%, a follow-up rate of 70.5% for the comparison and 66.8% for the intervention group. The interventions group reported a significant increase in consistent condom use with a reduction in STI incidence compared to no significant change in the comparison group. Conclusions The qualitative inquiry approaches to gain access, to foster participation and to develop a culturally appropriate intervention, along with the census enumeration technique application to estimate the FEW population sizes has led to successful intervention implementation as well as safer sexual behaviour and STI incidence reduction. Trial registration ClinicalTrials.gov, NCT02780986. Registered 23 May 2016 (retrospectively registered). Electronic supplementary material The online version of this article (10.1186/s12992-018-0358-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Raymond Boon Tar Lim
- Saw Swee Hock School of Public Health, National University of Singapore, Tahir Foundation Building, 12 Science Drive 2, #10-01, Singapore, Singapore city, 117549, Singapore
| | - Olive N Y Cheung
- Saw Swee Hock School of Public Health, National University of Singapore, Tahir Foundation Building, 12 Science Drive 2, #10-01, Singapore, Singapore city, 117549, Singapore
| | - Dede Kam Tyng Tham
- Saw Swee Hock School of Public Health, National University of Singapore, Tahir Foundation Building, 12 Science Drive 2, #10-01, Singapore, Singapore city, 117549, Singapore
| | - Hanh Hao La
- Saw Swee Hock School of Public Health, National University of Singapore, Tahir Foundation Building, 12 Science Drive 2, #10-01, Singapore, Singapore city, 117549, Singapore
| | - Thein Than Win
- Humanitarian Organisation for Migration Economics (HOME), 304 Orchard Road, #06-22, Lucky Plaza, Singapore, Singapore city, 238863, Singapore
| | - Roy Chan
- Saw Swee Hock School of Public Health, National University of Singapore, Tahir Foundation Building, 12 Science Drive 2, #10-01, Singapore, Singapore city, 117549, Singapore.,Department of Sexually Transmitted Infections Control, National Skin Centre, 31 Kelantan Lane, #01-16, Singapore, Singapore city, 200031, Singapore
| | - Mee Lian Wong
- Saw Swee Hock School of Public Health, National University of Singapore, Tahir Foundation Building, 12 Science Drive 2, #10-01, Singapore, Singapore city, 117549, Singapore.
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Lim RBT, Cheung ONY, Tai BC, Chen MIC, Chan RKW, Wong ML. Efficacy of multicomponent culturally tailored HIV/ STI prevention interventions targeting foreign female entertainment workers: a quasi-experimental trial. Sex Transm Infect 2018; 94:449-456. [PMID: 29444997 DOI: 10.1136/sextrans-2017-053203] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 12/11/2017] [Accepted: 01/15/2018] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES We assessed the efficacy of a multicomponent culturally tailored HIV/STI prevention intervention programme on consistent condom use and STI incidence among foreign Thai and Vietnamese female entertainment workers (FEWs) in Singapore. METHODS We conducted a quasi-experimental pretest and post-test intervention trial with a comparison group. We recruited 220 participants (115 Vietnamese and 105 Thai) for the comparison group, followed by the intervention group (same number) from the same sites which were purposively selected after a 3-month interval period. Both groups completed a self-administered anonymous questionnaire and STI testing for cervical gonorrhoea and Chlamydia, as well as pharyngeal gonorrhoea at baseline and 6-week follow-up. The peer-led intervention consisted of behavioural (HIV/STI education and condom negotiation skills), biomedical (STI screening and treatment services) and structural components (access to free condoms). We used the mixed effects Poisson regression model accounting for clustering by establishment venue to compute the adjusted risk ratio (aRR) of the outcomes at follow-up. RESULTS At follow-up, the intervention group was more likely than the comparison group to report consistent condom use for vaginal sex with paid (aRR 1.77; 95% CI 1.71 to 1.83) and casual (aRR 1.81; 95% CI 1.71 to 1.91) partners. For consistent condom use for oral sex, this was aRR 1.50; 95% CI 1.23 to 1.82 with paid and aRR 1.54; 95% CI 1.22 to 1.95 with casual partners. STI incidence at follow-up was significantly lower in the intervention (6.8 per 100 FEWs) than the comparison (14.8 per 100 FEWs) group (aRR 0.42; 95% CI 0.32 to 0.55). CONCLUSIONS This trial was effective in promoting consistent condom use for vaginal and oral sex as well as reducing STI incidence among the foreign Thai and Vietnamese FEWs in Singapore. The feasibility of scaling up the interventions to all entertainment establishments in Singapore should be assessed.
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Affiliation(s)
- Raymond B T Lim
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Olive N Y Cheung
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Bee Choo Tai
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Mark I-C Chen
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.,Institute of Infectious Diseases and Epidemiology, Communicable Disease Centre, Tan Tock Seng Hospital, Singapore
| | - Roy K W Chan
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.,Department of Sexually Transmitted Infections Control, National Skin Centre, Singapore
| | - Mee Lian Wong
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
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