Cargando…

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

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...

Descripción completa

Detalles Bibliográficos
Autores principales: Lim, Raymond Boon Tar, Cheung, Olive N. Y., Tham, Dede Kam Tyng, La, Hanh Hao, Win, Thein Than, Chan, Roy, Wong, Mee Lian
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5902891/
https://www.ncbi.nlm.nih.gov/pubmed/29661249
http://dx.doi.org/10.1186/s12992-018-0358-5
_version_ 1783314835748945920
author Lim, Raymond Boon Tar
Cheung, Olive N. Y.
Tham, Dede Kam Tyng
La, Hanh Hao
Win, Thein Than
Chan, Roy
Wong, Mee Lian
author_facet Lim, Raymond Boon Tar
Cheung, Olive N. Y.
Tham, Dede Kam Tyng
La, Hanh Hao
Win, Thein Than
Chan, Roy
Wong, Mee Lian
author_sort Lim, Raymond Boon Tar
collection PubMed
description 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.
format Online
Article
Text
id pubmed-5902891
institution National Center for Biotechnology Information
language English
publishDate 2018
publisher BioMed Central
record_format MEDLINE/PubMed
spelling pubmed-59028912018-04-23 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 Lim, Raymond Boon Tar Cheung, Olive N. Y. Tham, Dede Kam Tyng La, Hanh Hao Win, Thein Than Chan, Roy Wong, Mee Lian Global Health Methodology 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. BioMed Central 2018-04-16 /pmc/articles/PMC5902891/ /pubmed/29661249 http://dx.doi.org/10.1186/s12992-018-0358-5 Text en © The Author(s). 2018 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Methodology
Lim, Raymond Boon Tar
Cheung, Olive N. Y.
Tham, Dede Kam Tyng
La, Hanh Hao
Win, Thein Than
Chan, Roy
Wong, Mee Lian
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
title 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
title_full 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
title_fullStr 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
title_full_unstemmed 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
title_short 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
title_sort 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
topic Methodology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5902891/
https://www.ncbi.nlm.nih.gov/pubmed/29661249
http://dx.doi.org/10.1186/s12992-018-0358-5
work_keys_str_mv AT limraymondboontar usingqualitativeandcommunitybasedengagementapproachestogainaccessandtodevelopaculturallyappropriatestipreventioninterventionforforeignfemaleentertainmentworkersinsingapore
AT cheungoliveny usingqualitativeandcommunitybasedengagementapproachestogainaccessandtodevelopaculturallyappropriatestipreventioninterventionforforeignfemaleentertainmentworkersinsingapore
AT thamdedekamtyng usingqualitativeandcommunitybasedengagementapproachestogainaccessandtodevelopaculturallyappropriatestipreventioninterventionforforeignfemaleentertainmentworkersinsingapore
AT lahanhhao usingqualitativeandcommunitybasedengagementapproachestogainaccessandtodevelopaculturallyappropriatestipreventioninterventionforforeignfemaleentertainmentworkersinsingapore
AT wintheinthan usingqualitativeandcommunitybasedengagementapproachestogainaccessandtodevelopaculturallyappropriatestipreventioninterventionforforeignfemaleentertainmentworkersinsingapore
AT chanroy usingqualitativeandcommunitybasedengagementapproachestogainaccessandtodevelopaculturallyappropriatestipreventioninterventionforforeignfemaleentertainmentworkersinsingapore
AT wongmeelian usingqualitativeandcommunitybasedengagementapproachestogainaccessandtodevelopaculturallyappropriatestipreventioninterventionforforeignfemaleentertainmentworkersinsingapore