scholarly journals Conformity and communal decision-making: First-tester effects on acceptance of home-based HIV counseling and testing in Uganda

Author(s):  
Mari Armstrong-Hough ◽  
Amanda J Meyer ◽  
Achilles Katamba ◽  
J. Lucian Davis

Background: Individuals’ observation of how group members ahead of them behave can profoundly shape their perceptions, judgements, and subsequent behaviors. Moreover, social influence theories from the sociology of networks suggest that individuals’ social status and social network position determine the scope of their influence on other group members. We set out to examine the role of conformity and communal decision-making in shaping individual decisions to test for HIV during home-based TB contact investigation in Kampala, Uganda. Methods: We analyzed the HIV testing decisions of individuals who were offered free, optional, home-based HIV testing during a home visit by community health workers. We used generalized estimating equations (GEE) to estimate how the testing decision made by the first individual in a household offered testing influenced the subsequent testing decisions of other household members. Results: Community health workers visited 55 households with two or more eligible household members and offered 160 individuals HIV testing. Seventy-five (47%) declined the test. Individuals in households where the first person invited declined HIV testing had four times the risk of declining themselves (RR: 3.96, 95% CI: 1.7-9.0, p=0.001) compared to individuals in households where the first person invited agreed to HIV testing, controlling for individual age and gender. Conclusions: The decision of the first individual offered HIV testing seems to influence the decisions of subsequent household members when they are also offered testing. Even when results are confidential, individual decisions may be shaped by the testing behavior of the first household member offered the test.

2018 ◽  
Author(s):  
Mari Armstrong-Hough ◽  
Amanda J Meyer ◽  
Achilles Katamba ◽  
J. Lucian Davis

Background: Individuals’ observation of how group members ahead of them behave can profoundly shape their perceptions, judgements, and subsequent behaviors. Moreover, social influence theories from the sociology of networks suggest that individuals’ social status and social network position determine the scope of their influence on other group members. We set out to examine the role of conformity and communal decision-making in shaping individual decisions to test for HIV during home-based TB contact investigation in Kampala, Uganda. Methods: We analyzed the HIV testing decisions of individuals who were offered free, optional, home-based HIV testing during a home visit by community health workers. We used generalized estimating equations (GEE) to estimate how the testing decision made by the first individual in a household offered testing influenced the subsequent testing decisions of other household members. Results: Community health workers visited 55 households with two or more eligible household members and offered 160 individuals HIV testing. Seventy-five (47%) declined the test. Individuals in households where the first person invited declined HIV testing had four times the risk of declining themselves (RR: 3.96, 95% CI: 1.7-9.0, p=0.001) compared to individuals in households where the first person invited agreed to HIV testing, controlling for individual age and gender. Conclusions: The decision of the first individual offered HIV testing seems to influence the decisions of subsequent household members when they are also offered testing. Even when results are confidential, individual decisions may be shaped by the testing behavior of the first household member offered the test.


2018 ◽  
Author(s):  
Mari Armstrong-Hough ◽  
Amanda J Meyer ◽  
Achilles Katamba ◽  
J. Lucian Davis

Background: Individuals’ observation of how group members ahead of them behave can profoundly shape their perceptions, judgements, and subsequent behaviors. Moreover, social influence theories from the sociology of networks suggest that individuals’ social status and social network position determine the scope of their influence on other group members. We set out to examine the role of conformity and communal decision-making in shaping individual decisions to test for HIV during home-based TB contact investigation in Kampala, Uganda. Methods: We analyzed the HIV testing decisions of individuals who were offered free, optional, home-based HIV testing during a home visit by community health workers. We used to generalized estimating equations (GEE) to estimate how the testing decision made by the first individual in a household offered testing influenced the subsequent testing decisions of other household members. Results: Community health workers visited 55 households with two or more eligible household members and offered 160 individuals HIV testing. Seventy-five (47%) declined the test. Individuals in households where the first person invited declined HIV testing had four times the risk of declining themselves (RR: 3.96, 95% CI: 1.7-9.0, p=0.001) compared to individuals in households where the first person invited agreed to HIV testing, controlling for individual age and gender. Conclusions: The decision of the first individual offered HIV testing seems to influence the decisions of subsequent household members when they are also offered testing. Even when results are confidential, individual decisions may be shaped by the testing behavior of the first household member offered the test.


2009 ◽  
Vol 28 (4) ◽  
pp. 304-310 ◽  
Author(s):  
Abdullah H. Baqui ◽  
Shams E. Arifeen ◽  
Emma K. Williams ◽  
Saifuddin Ahmed ◽  
Ishtiaq Mannan ◽  
...  

2018 ◽  
Vol 111 (12) ◽  
pp. 453-461 ◽  
Author(s):  
Benedict Hayhoe ◽  
Thomas E Cowling ◽  
Virimchi Pillutla ◽  
Priya Garg ◽  
Azeem Majeed ◽  
...  

Objective To model cost and benefit of a national community health worker workforce. Design Modelling exercise based on all general practices in England. Setting United Kingdom National Health Service Primary Care. Participants Not applicable. Data sources Publicly available data on general practice demographics, population density, household size, salary scales and screening and immunisation uptake. Main outcome measures We estimated numbers of community health workers needed, anticipated workload and likely benefits to patients. Results Conservative modelling suggests that 110,585 community health workers would be needed to cover the general practice registered population in England, costing £2.22bn annually. Assuming community health workerss could engage with and successfully refer 20% of eligible unscreened or unimmunised individuals, an additional 753,592 cervical cancer screenings, 365,166 breast cancer screenings and 482,924 bowel cancer screenings could be expected within respective review periods. A total of 16,398 additional children annually could receive their MMR1 at 12 months and 24,716 their MMR2 at five years of age. Community health workerss would also provide home-based health promotion and lifestyle support to patients with chronic disease. Conclusion A scaled community health worker workforce integrated into primary care may be a valuable policy alternative. Pilot studies are required to establish feasibility and impact in NHS primary care.


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