Predicting adolescent willingness to participate in HIV vaccine trials: the role of sensation seeking

Kafaar, Zuhayr (2015-12)

Thesis (PhD)--Stellenbosch University, 2015

Thesis

ENGLISH ABSTRACT : Background: The prevalence rate of HIV for all age groups across South Africa is 12.6%, with approximately 6 422 179 South Africans living with the virus as of this writing. Approximately 469 000 new cases of HIV per year are reported. One of the promising technologies in development to reduce HIV incidence is an HIV vaccine. To be effective, vaccination must occur before exposure to the disease-producing agent, i.e., before sexual debut. An effective HIV vaccine must therefore be tested in adolescent populations. Objectives: The first objective of the study was to determine the facilitators of and barriers to adolescent willingness to participate (WTP) in a hypothetical HIV vaccine clinical trial. The second objective was to determine which variables predicted adolescent WTP and what role sensation seeking would play in the relationship between the predictors of adolescent WTP and adolescent WTP. Methodology: In the qualitative phase of the study I used purposive sampling to enrol the adolescent community advisory board (CAB) of the PHRU based at Chris Hani Baragwanath Hospital in Soweto which is a potential HIV vaccine clinical trial site. I conducted three focus group discussions (FGD) with the 25 CAB members, which were audio-recorded and transcribed. I analysed the transcriptions thematically and identified five barriers to and 11 facilitators of adolescent WTP in a hypothetical HIV vaccine clinical trial. In the quantitative phase of the study I developed a survey on the basis of the results from the qualitative phase. Based on prior research, I selected those facilitators of adolescent WTP that could be psychometrically measured to determine the variables that predicted adolescent WTP and the role of sensation seeking in this relationship. I recruited 467 participants from five high schools in Soweto for the quantitative phase of the study. Results: FGD participants identified five barriers: i) admitting sexual activity to an older individual; ii) difficulty in agreeing to participate; iii) potential side effects; iv) parents’ concerns for their children; and; v) stigma, and eleven facilitators: i) perceived safety of the candidate vaccine; ii) potential rewards of participation; iii) salience of HIV; iv) positive peer pressure; v) social status; vi) personality characteristics; vii) congruent messages in communities; viii) increased information; ix) risk behaviour; x) altruism; and xi) leadership. I selected altruism, sexual risk behaviour, leadership, personality characteristics, and social status in addition to WTP and sensation seeking as the variables to include in the survey. I conducted regression analyses to determine which variables predicted adolescent WTP. Only altruism and leadership statistically predicted WTP (p<.001), accounting for 9.4% and 17.2% of the variance in adolescent WTP, respectively. Product-term regression analysis showed that altruism and leadership directly influenced adolescent WTP independently of each other. Conclusion: Contrary to Swartz et al. (2005), sensation seeking did not predict adolescent willingness to participate in an HIV vaccine clinical trial. However, leadership and altruism confirmed the literature on adult WTP, in that they both predicted adolescent willingness to participate in an HIV vaccine clinical trial independently of each other.

AFRIKAANSE OPSOMMING : Agtergrond: Die voorkomssyfer van MIV vir alle ouderdomsgroepe regoor Suid-Afrika is 12,6%, met ongeveer 6 422 179 Suid-Afrikaners besmet met MIV. Ongeveer 469 000 nuwe gevalle van MIV per jaar word aangemeld. Een van die belowende tegnologieë wat tans ontwikkel word om die voorkoms van MIV te verminder, is 'n MIV-entstof. Om effektief te wees, moet inenting voorkom voor die blootstelling aan die siekte vervaardigingsagent, d.w.s. voor seksuele debuut. 'n Effektiewe MIV-entstof moet dus getoets word in adolessente bevolkings. Doelwitte: Die eerste doelwit van die studie was om die fasiliteerders van, en hindernisse tot adolessente bereidswilligheid om deel te neem (BDM) aan 'n hipotetiese MIV-entstof kliniese proef. Die tweede doelwit was om te bepaal watter veranderlikes adolessente BDM voorspel en watter rol sensasie soek sou speel in die verhouding tussen die voorspellers van adolessente BDM en adolessente BDM. Metodiek: Ek het doelgerigte steekproeftrekking gebruik om die adolessente gemeenskapsadviesraad (GAR) van die PHRU gebaseer op Chris Hani Baragwanath-hospitaal in Soweto, wat 'n potensiële MIV-entstof kliniese proef site is, in te skryf. Ek het drie fokusgroepbesprekings (FGB) met die 25 GAR-lede gehou. Ek het ʼn klankopname van die FGB’s gemaak en getranskribeer. Ek het die transkripsies tematies ontleed en vyf hindernisse tot en 11 fasiliteerders van adolessente BDM geïdentifiseer in 'n hipotetiese MIV-entstof kliniese proef. Ek het op grond van vorige navorsing die fasiliteerders van BDM wat psigometries gemeet kon word gekies, ten einde te bepaal watter veranderlikes adolessente BDM statisties voorspel en watter rol sensasie soek sou speel in die verhouding tussen die voorspellers van adolessente BDM en adolessente BDM. Ek het 467 deelnemers gewerf uit vyf hoërskole in Soweto vir Fase 2 van die studie. Resultate: FGB deelnemers het vyf hindernisse geïdentifiseer: i) om seksuele aktiwiteit te erken aan 'n ouer individu; ii) probleme om in te stem om deel te neem; iii) potensiële newe-effekte; iv) kommer wat ouers vir hulle kinders mag hê en; v) stigma, en elf fasiliteerders: i) veiligheid van die kandidaat entstof; ii) potensiële voordele van deelname; iii) opvallendheid van MIV; iv) positiewe groepsdruk; v) sosiale status; vi) persoonlikheidseienskappe; vii) kongruent boodskappe in gemeenskappe; viii) meer inligting; ix) risiko gedrag; x) altruïsme; en xi) leierskap. Ek het altruïsme, seksuele risiko gedrag, leierskap, persoonlikheidseienskappe en sosiale status gekies om as veranderlikes in die opname in te sluit asook BDM en sensasie soek. Ek het regressie-ontledings onderneem om te bepaal watter veranderlikes adolessente BDM voorspel. Slegs altruïsme en leierskap het BDM statisties voorspel (p <0,001). Altruïsme was verantwoordelik vir 9,4% van die variansie in BDM, terwyl leierskap vir 17,2% van die variansie in adolessente BDM verantwoordelik was. Produk-term regressie analise het getoon dat altruïsme en leierskap adolessente BDM direk beïnvloed, onafhanklik van mekaar. Gevolgtrekking: In teenstelling met Swartz et al. (2005), voorspel sensasie soek nie adolessente bereidwilligheid om deel te neem in 'n MIV-entstof kliniese proef nie. Leierskap en altruïsme bevestig die literatuur oor volwasse BDM, in dat hulle albei onafhanklik van mekaar adolessente bereidwilligheid om deel te neem in 'n MIV-entstof kliniese proef voorspel.

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