Effectiveness of Mobile Phone Text Messages in Uptake of Voluntary Medical Male Circumcision in Shinyanga Region

Volume 8, Issue 10, October – 2023 International Journal of Innovative Science and Research Technology
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Effectiveness of Mobile Phone

Text Messages in Uptake of
Voluntary Medical Male Circumcision in
Shinyanga Region
Benedicto Luvanda
A Dissertation Submitted to the Department of Journalism and Mass Communication St.

Augustine University of Tanzania in Partial Fulfilment of the Requirements for the Award of
Master of Arts in Mass Communication
IJISRT23OCT1440 www.ijisrt.com 1893

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CERTIFICATION
The undersigned certifies that she has read and hereby recommends for acceptance by the St. Augustine University of
Tanzania dissertation tittle: Effectiveness of Mobile Phone Text Messages in Uptake of Voluntary Medical Male Circumcision in
Shinyanga Region.
Signature………………………………………… Date…………………………
Dr. Joyce Bazira (PhD)

Department of Journalism and Mass Communication

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DECLARATION
I understand the nature of plagiarism, and I am aware of the Saint Augustine University’s policy on this. I declare that this
dissertation report is original work by me during my University project. Whatever has been quoted in this report, the author was
acknowledged.
Signature: ………………………… Date: ………………………………………….
Benedicto Luvanda (MAMC 50271/2016)

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ACKNOWLEDGEMENT
No part of this research could have been completed without the support of many peoples and institutions both from within
the university society and outside of the university. There is insufficiency space to mention every who helped into successful
completion of this research. However, I shall mention few and of those I do not mention by name, please be assured that Luvanda,
Benedicto is grateful for your support.
Special thanks goes to administration team of St. Augustine University who provided practical, moral and material support.
Very special thanks to Dr Joyce Bazira who supervised the whole study process. I would like to thank her for advice and time
dedicated to make sure that this research is successful completed.
It will be unforgivable sin not to thanks, Mr. Samson Luvanda for proof reading and type setting. Special mention should be
made to those who contributed into completion of this process including Theresia Mendoza
Luvanda Benedicto.

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DEDICATION
To my wife Theresia Mendoza and parents late Osward Luvanda and Saphina Mbena whose concern for academic
excellence inspired the writing of this research

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TABLE OF CONTENTS
CERTIFICATION .......................................................................................................................... 1894
DECLARATION ............................................................................................................................ 1895
ACKNOWLEDGEMENT .............................................................................................................. 1896
DEDICATION ................................................................................................................................ 1897
TABLE OF CONTENTS ............................................................................................................... 1898
LIST OF TABLES .......................................................................................................................... 1899
LIST OF FIGURES ........................................................................................................................ 1900
ABBREVIATIONS ......................................................................................................................... 1901
ABSTRACT ..................................................................................................................................... 1902
CHAPTER ONE: GENERAL INTRODUCTION: ..................................................................... 1903
A. Introduction to the chapter .......................................................................................................... 1903
B. Backgrounds of the Study ........................................................................................................... 1903
C. Statement of the problem ............................................................................................................ 1904
D. Objectives of the study ................................................................................................................ 1904
E. Research questions ...................................................................................................................... 1904
F. Significance of the study ............................................................................................................. 1905
G. Limitations of the study............................................................................................................... 1905
CHAPTER TWO: LITERATURE REVIEW .............................................................................. 1906
B. Definition of the key terms .......................................................................................................... 1906
C. Situating the research within the field of health Communication ............................................... 1906
D. Review of Relevant theories........................................................................................................ 1907
E. Previous Research on the Topic .................................................................................................. 1908
 Mobile phone Text messages ...................................................................................................... 1908
 Assessing Effectiveness of communication in Health. ................................................................ 1909
F. Rationale for the Study ................................................................................................................ 1910
CHAPTER THREE: RESEARCH METHODOLOGY .............................................................. 1911
B. Approach to the study ................................................................................................................. 1911
C. Area of the study ......................................................................................................................... 1911
D. Target population ........................................................................................................................ 1911
E. Sample and Sampling technique ................................................................................................. 1911
F. Data collection methods .............................................................................................................. 1911
G. Data management and analysis ................................................................................................... 1912
 Data Management ....................................................................................................................... 1912
 Data Analysis .............................................................................................................................. 1912
H. Validation of research instruments .............................................................................................. 1912
CHAPTER FOUR: DATA PRESENTATION AND INTERPRETATION .............................. 1913
B. Presentation of the research findings ........................................................................................... 1913
 What Kind of Mobile Phone Text Messages Were Communicated? .......................................... 1913
 Is There Any Direct Relationship Between Mobile Text Messages and Uptake of Voluntary
Medical Male Circumcision? ...................................................................................................... 1914
 How Mobile Phone Text Messages Changed Community Perception on VMMC? .................... 1916
C. Chapter Summary ........................................................................................................................ 1917
CHAPTER 5: SUMMARY OF FINDINGS, DISCUSSIONS, CONCLUSION AND
RECOMMENDATIONS ................................................................................................................ 1918
B. Discussion ................................................................................................................................... 1918
C. Conclusion................................................................................................................................... 1919
D. Recommendations ....................................................................................................................... 1920
 Recomendations and Suggestions for further research ............................................................... 1920
REFERENCES................................................................................................................................ 1921
APPENDICES ................................................................................................................................. 1926
APPENDIX I: FOCUS GROUP DISCUSSION ........................................................................... 1926
APPENDIX II: INTERVIEW GUIDE FOR SMS RECIPIENTS .............................................. 1927
APPENDIX III: TEXT MESSAGES WHICH WERE COMMUNICATED ............................ 1928

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LIST OF TABLES
Table 1: Menu of Communication Message Outcomes That May Contribute to Individual Behaviour Change and service uptake
.......................................................................................................................................................... 1910
Table 2: Number of text messages developed on different topics..................................................... 1913
Table 3: This table is copied from IEC Materials reviewing guide showing important issues to consider when developing text
messages. The third column is not part of the original table ............................................................. 1914

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LIST OF FIGURES
Figure 1: People’s opinions on how receiving text messages contributed into their opinion to go for
VMMC .............................................................................................................................................. 1916
Figure 2: Trans-theoretical Model .................................................................................................... 1919
Figure 3: Young boys escorted with their mothers waiting for VMMC Service in one of the service
provision site in Shinyanga (before mobile phone text messages).................................................... 1930
Figure 4: Adult men waiting for VMMC service after receiving text messages in their mobile
phones ............................................................................................................................................... 1930

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ABBREVIATIONS
AIDS: Acquired Immunodeficiency Syndrome

CDC: Center for Disease Control
HIV: Human Immunodeficiency Syndrome
ID: Identity
IEC: Information Education Communication
NACP: National AIDS Control Program
MC: Male Circumcision
MoHSW: Ministry of Health & Social Welfare
PEPFAR: President Emergency Plan for AIDS Relief
PA: Public Addressing
PDA: A personal digital assistant
SMS: Short Message Service
TAYOA: Tanzania Youth Alliance
TCRA: Tanzania Communication Regulatory Authority
TMI: Text Message Interventions
TTM: Trans theoretical Model
TPB: Theory of planned behavior
US: United State
VMMC: Voluntary Medical Male Circumcision

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ABSTRACT
Given the relevance of mobile phone text messages in today's technologically advanced society, this study examines
the of effectiveness of mobile phone text messages in increasing uptake of Voluntary Medical male circumcision (VMMC)
service in Shinyanga region. The study also attempts to access what makes mobile phones text messages effective and how
they impact target audience A telephone based focus group discussion interviews and contents analysis were used to collect
data to know if mobile phone text messages contributed in increased uptake of voluntary medical male circumcision
among sexually active adult men aged between 19-49 in Shinyanga region, to learn what was communicated through text
messages and how text messages recipients changed their perception toward VMMC after receiving text messages
Research findings show that text messages were not only providing information but they were also providing motivation
and helping to address structural barriers which were limiting people from accessing the service hence increasing service
uptake. While this study acknowledges again the effectiveness of mobile phone text messages in increasing uptake of
voluntary medical male circumcision, it shows how important it is for text messages to address real challenges and for the
text messages to address real challenges baseline assessment is important. There is a need for further studies to focus on
comparing knowledge and altitude between those who received text messages and those who did not. Response from focus
group discussion, and interviews makes it interesting to involve others from the same community who were not receiving
text messages.

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CHAPTER ONE
GENERAL INTRODUCTION
A. Introduction to the Chapter

This chapter sets the scene for this research and is divided into seven sections. The first part provides background of the
study, the second part (statement of the problem) consists of brief description of what is the problem that need to be addressed
with this study. The third part (objective of the study) answers the question to why this study is done and the fourth part consists
of questions that need to be answered in this study. The last three parts consist of Significance of the study, Limitations of the
study and definition of key terms.
B. Backgrounds of the Study

In 2007, the United Nations recommended provision of Voluntary medical male circumcision (VMMC) in settings with high
Human Immunodeficiency Virus (HIV) prevalence and low rates of male circumcision (MC). This recommendation was based on
randomized studies in Africa, which demonstrated that male circumcision reduces the acquisition of HIV by between 38% and
66%. Tanzania was among 13 countries selected for early implementation. In response, IntraHealth, through the US President’s
Plan for AIDS Relief (PEPFAR/Centres for Disease Control & Prevention (CDC), supported the Tanzania Ministry of Health &
Social Welfare (MOHSW) to launch a Voluntary medical male circumcision program in Shinyanga region where HIV prevalence
is high (7.4%) and VMMC is low (32%).
From October 2010 to September 2012, 65,812 males in Tanzania were circumcised in this campaign, of which only 7.1%
were men over 20 years. Existing evidence proves that older men between the ages of 30-49 have the highest risk of contracting
HIV and thus in greater need of the protective effects of VMMC yet significant cultural and attitudinal barriers hinder male
circumcision acceptance and uptake in this population. To maximize the impact of VMMC, the project implemented an intensive
social mobilization initiative that utilizes mobile phone text messaging and community sensitization activities targeting older men
over 19 years.
From October 2012, IntraHealth in partnership with the Tanzania Youth Alliance (TAYOA) conducted a demand creation
intervention for older men using mobile phone text messages. Mobile phone text messages were broadly adopted from the agreed
text in the ‘Male circumcision client information book’ put together by the Tanzania VMMC Technical Working Group. The
client information book was consulted by implementers and is used by them during counselling and demand creation activities. In
collaboration with district councils, IntraHealth and TAYOA organized community meetings with strategic VMMC messages to
sensitize community members on the availability and benefits of VMMC.
TAYOA and IntraHealth conducted VMMC information needs assessment to help them design relevant mobile phone text
messages to tackle some local myths and identified social norms and associated risks. Mobile phone text messages were designed
to appeal to the older men as each Short message service (SMS) is received as personal message tailored at that individual, mobile
phone text messages were also used to set a clinic appointment where by those who were receiving text messages had to show
their SMS to clinic service provider so as to get priority access to the service
This ‘personal mobile phone text messages appointment’ approach contrasts to previous situations when adults may have felt
discouraged. A high percentage of the Shinyanga population work in farming, and so there have been instances where adult males
having heard about the campaign, turned up and found they had to wait for a few hours, but then had to leave before getting seen,
due to work commitments. This SMS system of being able to show they have an appointment means their time is not wasted and
they are more likely to turn up knowing the slot has been booked for them.
TAYOA worked with popular opinion leaders to recruit clients during community sensitization activities six weeks prior to a
VMMC outreach campaign. Clients who expressed an interest in VMMC filled out a subscription card including their mobile
number, place of residence and consent to receive free mobile phone text messages. The client information was entered into the
TAYOA’s Mobile phone text message system. Subscribed clients were receiving text messages on daily basis with information
on definition, myths and misconceptions, the health benefits of VMMC for men and women, services provided, the availability
and dates of VMMC services. SMS reminders were sent to clients about service locations and times a week before each VMMC
outreach campaign. The clients who eventually received VMMC services filled in another card at the facility, which was entered
into text messages software and received post circumcision and follow-up instructions on proper wound care via mobile phone
text messages.
Project activities report proves that before the intervention, October 2010 - Sep 2012, only 7.1% of men circumcised were 20
years and above. During a nine-month intervention period (October 2012 to Jun 2013), a total of 63,873 men and boys were
circumcised. In quarter one of the project, 22% (5,054) of all men circumcised were 20 years or more; in quarter two, 28% (5,364)
and in quarter three, 32% (6,968) were 20 years or older. As further evidence of the effectiveness of the intervention, during the
third quarter, 29% (6,382) of clients were 20 years and above.

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Existing data was collected from the national VMMC Service register whose front page contains a section with questions on
why the client is attending. Closed ended questions include: Self Referred, Voluntary HIV Counselling and Testing, Provider
Initiated HIV Counselling and testing, and other.
The “Self-Referral” box was the most popular choice for adult men who were showing up for the service. Counsellors had to
probe further to find out if this self-referral is as a result of receiving a mobile phone text messages, talking to a community
mobilizer, hearing a PA announcement or talking to friends and family, and note this down where possible.
Providers would note if a client attended due to the TAYOA SMS in case the client was referred through TAYOA SMS
communication. Although there is evidence that there were an increasing number of adults who were going for the service there is
no clear link between mobile phone text messages and service uptake since there were many other demand creation activities
going on in the community.
C. Statement of the Problem

For a long time, inadequacy and unavailability of local studies to prove effectiveness or ineffectiveness of mobile phone text
messages for health service demand creation has placed mobile phone text messages between effective and ineffective way of
having health communication objectives reached. Absence of studies to prove effectiveness or ineffectiveness of mobile phone
text messages in meeting communication objective made it hard for communicators in health sector to decide whether to use text
messages only or not. As a result, decision to use text messages is considered as a trial, which might end with failure or success.
This study examined the effectiveness of mobile phone text messages in men’s uptake of voluntary medical male
circumcision in the Shinyanga region where text messages and other communication approaches were used to increase uptake of
voluntary medical male circumcision among adult men.
Existing evidence prove that using text messages for health communication and examining its effectiveness is not simple
since there are many other variables that may contribute into an individual decision to go for service. Existing project reports
from service points indicates that there were an increasing number of people who were going for the service from the time when
mobile phone text messages were engaged for demand creation. However, at the same time organizations were conducting other
activities in the community including working with popular opinion leaders, using public addressing system, radio promotions and
community meetings making it hard to attribute the increasing service uptake with mobile phone text messages only
This study examined the effectiveness of mobile phone text messages in uptake of voluntary medical male circumcision in
Shinyanga region learning directly from people who received text messages and document reviews (mobile phone text messages).
Despite of the fact that many health communicators are recently using text messages, still there were no proof whether text
messages are effective in increasing service uptake. Using the right content, delivered at the right time in the right context, is
critical. Having adding the right kind of interaction to communication makes text messages more engaging, and increases its
power in encouraging health service uptake. Positive health communication campaigns are important to be measurable and this is
not easy and this is particularly difficult when target audience cannot be accessed physically, and this is always the case with
mobile phone text messages
D. Objectives of the Study

The Objective of this study is to examine the effectiveness of mobile phone text messages in uptake of VMMC in Shinyanga.
Given the relevance of mobile phone text messages in today's technologically advanced society, the study involves general
examination of effectiveness of mobile phone text messages in increasing uptake VMMC service in Shinyanga region. The study
also attempts to access what makes mobile phones text messages effective and how they impact target audience
With this Specificity, this study had to accomplish the following tasks:
 To know if mobile phone text messages contributed in increased uptake of voluntary medical male circumcision among
sexually active adult men aged between 19-49 in Shinyanga region.
 To learn what was communicated through text messages
 To learn how text messages recipients changed their perception toward VMMC after receiving text messages
E. Research Questions
The objectives of this study are to find answers for the following questions:
 Is there any direct relationship between mobile text messages and men’s uptake of voluntary medical male circumcision?
 What kind of mobile phone text messages were communicated?
 How did mobile phone text messages change community perception on VMMC?

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F. Significance of the Study

This study was design to find useful information on the effectiveness of mobile phone text messages in men’s uptake of
Voluntary medical male circumcision. Results from this study provide vital information for health communicators in taking
appropriate action toward the choice of effective ways of increasing health service uptake and make the use of mobile phone text
messages more useful.
The study also is a footprint to direct health communicators on what works and what does not work especially when it comes
to using mobile phone text messages for health communication particularly in promoting heath service uptake
This study also helps communicators particularly in the health sector to know what should be done to make mobile phone
text messages more effective in health service promotion and the demand for health services
The study validates the possible links between mobile phone text messages and Health service uptake by learning from
message recipient to know if received text messages contributed into their decision to go for the service. Ultimately, at the end it
recommends possible strategies in connecting missing links between mobile phone text messages and health service uptake
In Tanzania this might be the first research examining effectiveness the of mobile phone text messages in uptake of
voluntary medical male circumcision. The point of emphasis in this research was to know if mobile phones are effective or not, if
they are not, the survey was designed to find out the answer why they are not? And if they are effective still there was a questions
of what makes mobile phone test message effective and to whom and when text messages are more effective
G. Limitations of the Study

In the process this study faced the difficulty in isolating the specific effects of mobile phone text messages from that of other
communication campaigns. There was a challenge in recalling other external influences that contributed into increased uptake of
VMMC services.
Information in this evaluation is self-reported, which likely introduces some bias toward answers respondents think the
interviewer wanted to hear. However, through the use of technology (telephone focus group discussion and telephone interviews)
confidentiality and anonymity made it easy for respondents to answer honestly
Many people do not keep records on what influenced them to go for the service and most of them do not feel comfortable
discussing about sexual reproductive health especially when the discussion involves reproductive organs
Lack of enough fund was another limitation of the whole process of the study especially sample selection. Absence of
enough funds made it hard to find an ideal study sample thus the sample for study included few randomly selected message
recipients responding to the financial ability to cover the cost for telephone interviews.
The fact that this area is not well researched in Tanzania also hindered the study, since it resulted into lack of data and home
reviews to support the study.

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CHAPTER TWO
LITERATURE REVIEW
This chapter presents the general conceptual issues of mobile phone text messages and how they are linked to increasing
uptake of health services. More than that this chapter gives general assessment on what makes demand creation initiatives
effective. Literature related to mobile phone text messages for communication health issues, demand creation and what makes
demand creation effective will be introduced with a specific focus on what other scholars wrote about mobile phone text messages
in general.
B. Definition Of The Key Terms
 Examine:
Online Cambridge dictionary defines examine as testing someone's knowledge or skills in a particular subject. Another
definition is looking or consider a person or thing carefully and in detail in order to discover about them. In this study examine
means look in close detail and establish the key facts and important issues surrounding an effectiveness of mobile phone text
messages in increasing uptake of VMMC in Shinyanga Region.
 Effectiveness:
According to Oxford dictionary effective means Successful in producing a desired or intended result. In this study
effectiveness of VMMC communication initiatives refers to the to the capabilities of producing a desired results/outcome/The
degree to which objectives are achieved and the extent to which targeted problems are solved (increased uptake of VMMC among
adult men and Increased knowledge) (Chib, Wilkin, Ling, Hoefman, & Van Biejma, 2012).
 Text Message:
Commonly referred to as SMS (Short Message Service) is sending short messages of up to 160 characters (224 characters if
using a 5-bit mode) to mobile devices, including cellular phones, smartphones and PDAs (“What is SMS Marketing?,” n.d.). Is a
service component of telephone, World Wide Web, and mobile telephony systems? It uses standardized communications
protocols to enable fixed line or mobile phone devices to exchange short text message.
 Mobile Phone:
Is a portable telephone that can make and receive calls over a radio frequency carrier while the user is moving within a
telephone service area (wikipedia, 2015). In this context A mobile phone is defined to as is a wireless handheld device that allows
users to make calls and send text messages, among other features. A mobile phone may also be known as a cellular phone or
simply cellphone (Techopedia, n.d.).
 Male Circumcision:
Is the removal of the foreskin from the human penis. In the most common procedure, the foreskin is opened, adhesions are
removed, and the foreskin is separated from the glans. After that, the circumcision device (if used) is placed, and then the foreskin
is cut off (Humphries, van Rooyen, Knight, Barnabas, & Celum, 2015; Price et al., 2014; Reed et al., 2012; Siegfried, Muller,
Deeks, & Volmink, 2010; Umar, Mandalazi, Jere, & Muula, 2013; Wikipedia, n.d.). In this study Male Circumcision refers to
voluntary surgical removal of the foreskin - the retractable fold of tissue that covers the head of the penis by trained health
professionals.
 mHealth:
Is a general term for the use of mobile phones and other wireless technology in medical care. The most common application
of mHealth is the use of mobile phones and communication devices to educate consumers about preventive health care services
(Arora, Peters, Burner, Lam, & Menchine, 2014; Margaret Rouse, n.d; World Health Organization, 2011).
C. Situating the Research within the Field of Health Communication

Communication in health takes place on many levels, including individual, group, organization, community or mass media.
Communication in health can be defined in much the same way as communication has generally been defined: a transactional
process. The main difference in communicating health is that the focus is not a general one but one specific to health information.
(Kreps, 2003) summarizes the addition of ‘health’ to the definition of communication as a ‘resource’ that allows health messages
(for example prevention, risk or awareness) to be used in the education and avoidance of ill health. This broad definition
incorporates the fact that health communication can take place at many levels and embodies a holistic approach to health
promotion.

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Health communication encompasses the study and use of communication strategies to inform and influence individual and
community decisions that enhance health. It links the domains of communication and health and is increasingly recognized as a
necessary element of efforts to improve personal and public health (Aarva, de Haes, & Visser, 1997; National Institutes of Health,
2013; Roxanne Parrott, 2004).
Health communication can contribute to all aspects of disease prevention and health promotion and is relevant in a number
of contexts, including (1) health professional-patient relations, (2) individuals’ exposure to, search for, and use of health
information, (3) individuals’ adherence to clinical recommendations and regimens, (4) the construction of public health messages
and campaigns, (5) the dissemination of individual and population health risk information, that is, risk communication, (6) images
of health in the mass media and the culture at large, (7) the education of consumers about how to gain access to the public health
and health care systems, and (8) the development of telehealth applications (National Institutes of Health, 2013; O’Toole, 2008;
Wilson, 2007).
For individuals, effective health communication can help raise awareness of health risks and solutions, provide the
motivation and skills needed to reduce these risks, help them find support from other people in similar situations, and affect or
reinforce attitudes (Kreps, 2003). Health communication also can increase demand for appropriate health services and decrease
demand for inappropriate health services. It can make available information to assist in making complex choices, such as selecting
health plans, care providers, and treatments (Piotrow et al., 1997).
For the community, health communication can be used to influence the public agenda, advocate for policies and programs,
promote positive changes in the socioeconomic and physical environments, improve the delivery of public health and health care
services, and encourage social norms that benefit health and quality of life.
The practice of health communication has contributed to health promotion and disease prevention in several areas. One is the
improvement of interpersonal and group interactions in clinical situations (for example, provider-patient, provider-provider, and
among members of a health care team) through the training of health professionals and patients in effective communication skills
(Piotrow et al., 1997).
Collaborative relationships are enhanced when all parties are capable of good communication. Another area is the
dissemination of health messages through public education campaigns that seek to change the social climate to encourage healthy
behaviors, create awareness, change attitudes, and motivate individuals to adopt recommended behaviors (Monaghan, 1968; RL.
Parrott, 2005).
D. Review of Relevant Theories

One of the central questions that communicators have been debating is whether mobile phone text messages are effective in
increasing uptake of health service or not? This is due to the fact that health service uptake is closely related with behavior
change. The specific factors influencing uptake of service (or its failure) are many but they can be classified into fewer groups
with some differences across theoretical perspectives. A number of theoretical models that use these groupings for explaining and
linking communication and health service uptake. This is study is based on transtheoretical Model
The transtheoretical model (TTM), more frequently referred to as the ‘stages of change’ model, is a cyclic model developed
by Prochaska & Diclemente 1983. The model suggests that people change their behavior and perceptions at certain stages in life,
rather than making one major change. During these incremental stages, they consider whether or not to make changes to their
behavior. This cyclic model is based on the premise that people are at different levels of readiness to change, and during the
change process they move through a series of stages. People move from precontemplation (not ready to change) to contemplation
(thinking of change), to preparation (getting ready to change), to action (performing the change), to maintenance (continuing the
change), to relapse (abandoning changes and reverting to former behaviors). A person may start at any of these stages and may
move between stages.
The TTM uses are extensive and the model has frequently been used in interventions with special targets and tailoring
information to appropriate stages of change. (Kidd, 2003) indicate that the TTM could provide precision when examining
effectiveness and long-term efficacy in an intervention. It has also been said that it is a model that is ‘simple, powerful, discerning
and practical’ (De Nooijer, J., Van Assema, P., De Vet, E. & Brug, 2005). One of the most appealing aspects of the TTM to
practitioners is its simplicity. Although originally designed for communication on smoking interventions, recently the TTM has
been used in areas that include promoting HIV service, injury prevention (Kidd, 2003) and physical activity (S. J. Marshall &
Biddle, 2001).

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According to Trans theoretical Model (TTM) it is true that before making behavioral changes, individuals progress through a
series of stages from pre-contemplation (not yet even considering a change) to action and maintenance. That action could be best
directed by targeting interventions at the appropriate stage, and that failure to operate on the same level of change can result in
resistance, are primary features of the TTM. A recent variant of the TTM is the Social-Cognitive Stage Model (Prochaska &
Velicer, 1997) which couples the classic stage model as found in the with determinants of stage movement from classic social
cognitive theory (Bandura, 1986). This means that in order to get men going for VMMC service developed text messages must be
able to take an individual through different stages as identified in Trans theoretical Model
The Precaution-Adoption-Process Model (Weinstein, 1988) is another stage based model that can be used to assess the
effectiveness of health communication initiatives, this model differs from other models in a sense it focuses on individual patterns
of change over time rather than on predicting behavior across individuals and with a special emphasis on reactions to health
hazards and precautionary behaviors. Both the Information-Motivation-Behavioral- Skills Model (Fisher & Fisher, 2002) and the
Information-Motivation- Strategy Model (DiMatteo & DiNicola, 1982; Martin, Haskard-Zolnierek, & DiMatteo, 2010; DiMatteo,
Haskard-Zolnierek, & Martin, 2012) take a simplification approach, noting that three basic elements are necessary if service
uptake or healthy changes, of whatever sort, are to be initiated and maintained. The former primarily targets behavioral skills in
the targeted population; whereas the latter addresses the extensiveness of the communication initiative, target audience motivation
and finally action.
In order to understand the health related behavior, change The Information-Motivation-Strategy Model (Fisher & Fisher,
2002) is also effective. This approach recognizes that in order for people to go for service they must first know what it is that they
are to be doing, in this sense they must know what is VMMC and why they are supposed to go for the service. This will be
followed by activities designed to make sure that target audience are appropriately motivated to engage in the necessary action
like communicating benefits, and, finally, they must have the resources to carry out the desired action.
According to Information-Motivation-Strategy Model any one or two of these elements is insufficient; all three are essential.
An individual may understand the importance to go for the service perfectly but have little interest in carrying it out; or the
individual might understand and be highly motivated but experience in surmountable barriers to effecting change. It is only when
all three factors are in place and are sustainable that healthy behaviors are possible. It is readily apparent that communication is
key to achieving each of the three requirements for health behavior change and treatment adherence.
Problems are created at the first stage of the model when information is not clearly explained, is omitted, or includes many
details without support for helping the recipient to remember the information. Once the needed information is in place, much can
be done to motivate target audience but only when there is a clear understanding of target audience life circumstances, concerns,
ideals, and goals. Thus, mobile phone text messages effective communication is, again, key. Finally, barriers can also be
addressed through mobile phone text messages, and individualized strategies can be developed for increasing health service
uptake only when the particular nature of individuals’ experiences and challenges are recognized. Mobile phone text messages can
facilitate the entire process.
E. Previous Research on the Topic
 Mobile Phone Text messages

According to the international telecommunication union (1985) The missing link: report of the Independent Commission for
World-Wide Telecommunications Development: In 1984, before the development and proliferation of mobile phones, more than
half of the world’s population lived in countries with one telephone for every 100 people, whereas two-thirds of all people
worldwide had no access to telephones. Thirty years later, mobile penetration has reached 90% in developing countries, there are
almost 7 billion mobile phone subscriptions worldwide, and the global mobile penetration rate reached 96% (ITU, 2014).
According to Tanzania Communication regulatory authority (TCRA) in quarterly communication statistics report (TCRA, 2016)
Quarter three, there are 35,920,090 mobile phone subscribers in Tanzania with an approximate of 45 million citizens it means that
75 percent of Tanzanians can access mobile phone services
Among the most frequently utilized interpersonal mobile communication channels is called short message service (SMS), or
text messages, involving the creation and real-time exchange of alphanumeric messages of 160 characters or fewer. These forms
of messaging have become ubiquitous, and an estimated three-quarters of all mobile users use text messaging (Sale, 2014). In the
United States, texting among adult mobile users in 2011 was higher among Hispanics (83%) and African Americans (76%) than
Whites (70%) (Zickuhr & Smith, 2012). In 2013, According to the report on annual wireless industry summary report 1.91 trillion
text messages were sent in the United States, and more than 8 trillion text messages were sent worldwide. However, texting rates
have dipped slightly in recent years following the availability of free mobile-messaging applications such as WhatsApp, Kik, and
Facebook Messenger. In Tanzania, for the period of July to September 2015 Tanzania Communication Regulatory Authority
issued the report that in three months’ period 13,330,829,144 text messages were sent.

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In addition to their frequent use and enormous reach, text and multimedia messaging have many other characteristics that
make them well suited for public health interventions. Although text-messaging interventions (TMIs) may be scalable at a
relatively low cost, and simple TMIs can reach large groups of people at a low cost per person, more complex interventions may
have a higher per capita cost. TMIs also have the potential to incorporate qualities often associated with more effective health
communication interventions, such as tailoring, interactivity, personalization, and/or high message repetition (Hubbard, 1953).
Furthermore, text messages appeal to users’ addiction-like desire to receive messages and the unconscious pleasure of the
dopamine release associated with this reward. As a result, it has been found that 99% of received mobile text messages are
opened, and 90% of all mobile text messages are read within three minutes of being received (A K Hall, Cole-Lewis, &
Bernhardt, 2015; Amanda K Hall, Cole-Lewis, & Bernhardt, 2015a, 2015b)
Text messaging for health is considered part of the larger strategy of mobile health (mHealth), which is the application of
mobile technologies to support and enhance the performance of health care and public health practice (Chib et al., 2012; World
Health Organization, 2011), the first study using text messaging for health was published in 2002 (Neville R, eta al), and it has
since been followed by dozens of other published studies and hundreds of largely unpublished pilot projects. The first systematic
review of texting for health was published in 2009 (Amanda K Hall et al., 2015a)and was subsequently followed by more than 20
published systematic reviews and meta-analyses, each one addressing a slightly different aspect of the application of text
messaging for improving or protecting health. The first known systematic review of reviews was published in 2014 and explored
findings from reviews of TMIs and health care delivery, including 13 systematic reviews, 3 of which focused on clinical
appointment reminders; however, only two databases were searched (Horvath T, at al 2012).
In Tanzania text messages has been linked with Improvements in health systems, where researchers found that a mobile
phone based integrated management of childhood illness manual resulted in improved adherence to treatment protocols by
healthcare workers (DeRenzi et al., 2012). Similar results were reported in Uganda, where wireless Personal digital assistance
used for disease surveillance also produced 24 per cent cost savings over the previous paper-based approach (Sasaki & Gebru
2008). In China, text message appointment reminders saved one-third of the cost of phone-call reminders (Leong et al., 2006;
Lund et al., 2012). Although these results are all promising, none of these applications were implemented on a large scale, or for a
protracted period of time, thus limiting their ability to be generalized to other settings.
 Assessing Effectiveness of Communication in Health.

Research evidence strongly supports the importance of effective communication in the process of delivering medical care, as
well as patient-cantered approaches to help individuals maintain healthy behaviors and adhere to recommended treatments (Doyle,
Lennox, & Bell, 2013).
While assessing effectiveness is scientific, health communication practitioners are not only encouraged to utilise tested
theories and methodologies in projects designing and implementation (European Centre for Disease Prevention and Contr (ECDC),
2014), it also becomes hard to but also to plan and employ better evaluation designs that are appropriate to the complexity of the
campaign activities (Rychetnik, Frommer, Hawe, & Shiell, 2006) However, many difficulties have been documented when
attempting to evaluate health communication campaigns, particularly in relation to the selection of appropriate evaluation designs
and indicators to measure the impact of the campaign on public health outcomes (World Health Organisation Europe et al., 2010)
In the area of disease prevention and control, the health impact of campaigns is usually measured in the form of increased
knowledge and service uptake. However, as it is in our case the campaign aimed also at changing behavior by increasing
awareness. Evaluating mobile phone text messages therefore may include knowledge, attitude and behavior surveys as a means of
assessment evaluation (Coffman, 2002)
In assessing effectiveness, short-term outcome measures such as message recall and recognition, attitudinal correlates of
targeted behavior, social norms, intentions to change, and behavior change (European Centre for Disease Prevention and Contr
(ECDC), 2014; Evans, Uhrig, Davis, & McCormack, 2009), are often chosen as they are predictive of longer term behavior
changes as outlined by theories of behavior change such as the Theory of Planned Behaviour (Icek Ajzen, 1987). Other short term
measures such as reactions to campaign materials, likeability or perceived message effectiveness are common but less informative
in terms of actual campaign effectiveness as they lack a strong theoretical basis (Evans et al., 2009)
It is also recommended that when choosing outcome measures that they are relevant to both the participants of the study and
to the broader health system context, including economic measures (Treadwell, Lucas, & Tsou, 2014) Others would propose that
if the campaign aims to generate action (for example, to increase uptake voluntary medical male circumcision) then at least
alternative measure of that action is necessary to convey campaign success (McOwan, Gilleece, Chislett, & Mandalia, 2002)

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Campaign exposure is a key outcome examined in most effectiveness assessments studies as various levels of exposure to
mobile phone text messages can be linked with varying levels of effectiveness such as a service uptake. The significance of
Campaign exposure as an outcome measure, however, is often open to discussion, as quite often it is measured by self-reporting,
which may have questionable reliability (Coffman, 2002) Process evaluation may aim to track campaign implementation by
examining frequency of message distribution regarding the specific media channel (Coffman, 2002).
(Naranbhai, Karim, & Meyer-Weitz, 2008) while reviewing studies from the USA, highlighted the need for self-reporting of
risky sexual behavior change to be supported by biological indicators such as HIV or STI prevalence and incidence rates
(Naranbhai et al., 2008). They also recommend future evaluation studies to utilize indicators that are based on a common set of
standardized outcome measures such as those laid out by the World Health Organization (programmatic indicators, determinant
indicators, behavioral indicators, and impact indicators) (European Centre for Disease Prevention and Contr (ECDC), 2014)
Similarly, a Canadian report recommends exploring communication outcomes on four levels, namely the individual, the network,
the organization and societal (Sixsmith, Doyle, & Barry, 2013), These would also help to reduce difficulties that may arise in
attempting to draw cross-country comparisons of campaign effectiveness.
For communication to effective there must a longer-term individual level outcome, these very short-term message outcomes
provide a complete picture of how behavior change may occur in a health communication campaign. It can be useful to focus on
these short-term message outcomes when evaluating communication campaign In other words, without evidence that a
communication campaign/message is achieving effects in the table below, it is very unlikely that it will contribute to behavior
change or increased service uptake.
Table 1 Menu of Communication Message Outcomes That May Contribute to Individual Behaviour Change and Service Uptake
1. Ability to recall the message (generally, as well as specific content
2. Reported knowledge gains from the message (i.e., new things learned).
3. Emotional reaction (liking, not being offended by) toward the message (tone, appeal)
4. Ability to understanding the message content
5. Beliefs about the accuracy and credibility of the message (Is the information in this message true? Do you agree with it?)
6. Attitude toward the message source
7. Attitude toward the messenger (in the ad/message)
8. Beliefs about whether the message is relevant (to someone like me)
9. Number of times the message is discussed with others
10. Content of the discussions about the message with others (number of positive mentions; number of negative mentions)
11. Reported skill gains from the message (i.e., new skills gained)
12. Reported influence by the incentives within the message (based on perceived gain or loss).
13. Actions taken to collect more information related to the topic of the message
14. Intention/plans made to act on the message
15. Actions taken toward the behavior recommended in the message
Source: Borrowed from (Jodi Thesenvitz & MacDonald, 2011)
F. Rationale for the Study

Resource allocation for health communication evaluation research is a recurring issue, as mass media campaigns alone are
perceived as expensive and high quality evaluation may be viewed as an unnecessary luxury to which the budget simply cannot
stretch (European Centre for Disease Prevention and Contr (ECDC), 2014). However, this may in a way render the campaign
itself a futile exercise, as evaluation is necessary to determine effectiveness, and if effectiveness is not established, an expensive
campaign may hold little benefit to public health outcomes, or worse, bring unintended harmful effects.
Determining the potential unintended effects of a communication campaign is a vital undertaking, particularly for
professionals in the area of communication. Further examination of the literature regarding communication for the prevention and
control of communicable diseases, in terms of considering unintended effects is of great important.
In Tanzania by 2013 there were five projects using mobile phone text messages listed in global mobile health project
summaries and there was only one project with formal evaluation results. 28 projects out of 94 projects had formal evaluation
results available making it hard to assess its effectiveness particularly of interventions like those of mobile phone text messages
for health since it is a new area that need more research to measure its effectiveness
Understanding the need for evaluation, this assessment is designed to fill existing information gap on effectiveness of mobile
phone text messages on increasing health service uptake. There is also a gap on how mobile phones text messages programs used
to be evaluated. For example, many project successes are reported by looking at number of subscribers and number text messages
sent while health communicators are suggesting that effectiveness must be measured by looking at communication efforts ability
to increase service uptake, change attitude, social norms and behaviours.

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CHAPTER THREE
RESEARCH METHODOLOGY
The methodology developed for this study is rooted in the conceptual framework that recognizes the effectiveness of mobile
phone text messages in increasing uptake of voluntary medical male circumcision. All methodologies for this study target at
assessing the effectiveness of mobile phone text messages in increasing uptake of VMMC services. In assessing effectiveness of
text messages designed methodologies helped in realising the study objectives including: assess the effectiveness of mobile phone
text messages in increasing uptake of voluntary medical male circumcision in Shinyanga region, Assess the possibility for text
messages recipient to act upon information received through text messages and suggest best approach through which mobile
phone text messages can be made even more effective.
B. Approach to the Study

This study employed the use of qualitative methods where by the main target was to conduct regression analysis in assessing
effectiveness of text messages in uptake of VMMC. Regression analysis helped in assessing the link/relationship between uptake
of VMMC services and mobile phone text messages.
Regression analysis also helped in ruling out whether the uptake of VMMC services was due to the effectiveness of mobile
phone text messages. It also helped to know how other variables contributed into increased uptake of VMMC services.
C. Area of the Study

This study was conducted in Shinyanga Tanzania where by people who were subscribed to the SMS systems are residing and
the project was implemented in the region for the sake of increasing uptake of VMMC services among adult men (19-49).
D. Target Population
Target population for this study was selected from the SMS database where by adult men aged between 19-49 living in
Shinyanga who were previously subscribed to the mobile phone text messaging system to receive text messages on VMMC. Text
messages were designed to increase uptake of voluntary medical male circumcision in the region and individuals were subscribed
to the SMS system by using their mobile phone numbers.
E. Sample and Sampling Technique

53317 men were subscribed to the SMS system to receive text messages on VMMC. The applied convenient sampling where
by 40 text message recipient who were expected to provide unique and rich information of value to the study were selected for the
study based on other demographic factors including age and residence.
Since VMMC is closely linked to sexual reproductive health and people might not feel comfortable to discuss about the
topic, 20 SMS recipient were reached through two sessions of 10 participants in each telephone based focus group discussion and
20 with semi structured telephone interview. The decision to conduct telephone focus group discussion came up as the result of
the fact that many men (who received text messages during the campaign) were no longer living in the same localities and those
who were still living in Shinyanga were not comfortable discussion about VMMC in face to face focus group discussion
Non-Probability sampling (convenience) respond to the nature of the study where by adult men who were previously
subscribed to mobile phone text messaging system are expected to provide useful feedback in assessing the effectiveness of text
messages in increasing access to voluntary medical male circumcision.
F. Data Collection Methods

Data collection methods comprised of mobile phone text messages content analysis, telephone focus group discussion and
telephone interviews. Selected methods responded to objectives of the research which was to assess effectiveness of mobile phone
text messages in increasing uptake of voluntary medical male circumcision. It was therefore important to know what text
messages were communicated and whether the communication initiative was effective or not. In general, these methods were
preferred because the research was aimed at exploring contents of communication, describe and make extrapolation about
characteristics of communication and at last explore the effect of communication to the targeted audience.

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G. Data Management and Analysis
 Data Management
For the sub-set of mobile phone text messages recipient who participate in an interview their mobile phone numbers
acted as a unique ID. Participant list along with verbal informed consent forms were administered prior to beginning the focus
group discussion and interviews. Data collection tools, consent forms, and recorded audio materials were named after the ID.
Completed interviews and focus group discussion contents were kept in a safe place that was accessible to research team leaders
for analysis.
The interviewers were recording during an interview focus group discussion. Recorded materials were expanded into
written notes after interview/focus group discussion. Interviews and focus group discussion audios as they were collected to
ensure quality and clarity.
 Data Analysis
Data were organized, collected information and begin the analysis by familiarizing with the data. Themes and recurring
issues were highlighted and categorised for further analysis.
Data were synthesized and interpreted according to research questions and to improve the validity of the answers,
triangulations were performed using the various data sets to help validate the accuracy of the findings. Notes taken/recorded in
Kiswahili and SMS contents were translated into English and integrated with other notes.
Thematic and content analysis were performed to establish whether the information addresses the assessment questions or
not.
H. Validation of Research Instruments

Focus group discussion and interviews were conducted by using a short guide for focus group discussion and interviews,
interviewers discussed with SMS recipients who consented verbally to participate in a focus group discussion or an interview. 10
mobile phone text messages recipient were interviewed using a short, qualitative questionnaire.
Interview guides were developed, translated from English to Kiswahili, and pilot-tested to ascertain their validity and
ascertain that respondents will understand the questions. Thereafter they were appropriately revised before using them to collect
primary data. The assessment team administer the interview and discussions in English, Kiswahili, or both, depending on the
respondent’s choice of language. To learn what was communicated (text messages) and I reviewed text messages from the text
messaging system.

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CHAPTER FOUR
DATA PRESENTATION AND INTERPRETATION
A. Introduction to the chapter
This chapter provides a detailed account of the findings from the study conducted to learn about effectiveness of mobile
phone text messages in increasing uptake of voluntary medical male circumcision. Accordingly, this chapter is structured into
three parts; the first part discusses findings from text messages contents analysis, the second part focuses on the analysis of focus
group discussion and interviews on the relationship between telephone text messages and uptake of Voluntary medical male
circumcision. The third part presents findings from focus group discussion and interviews on how mobile phone text messages
changed community perception on VMMC.
The methodology for this study, which had been discussed and explained in the previous chapter, has guided the data
collection as will have explained in this chapter. The focus of this chapter is to present the results of the focus group discussion
and interviews, a comparison of those findings with the relevant academic literature will be provided in the following Chapter.
B. Presentation of the Research Findings
 What Kind of Mobile Phone Text Messages Were Communicated?

The content of the text messages was developed from VMMC client textbook which was developed by Ministry responsible
for health in the United Republic of Tanzania. The textbook consisted of all important information for clients on VMMC. The
development of this textbook involved Tanzania VMMC Technical Working Group and they developed this book as reference
book for clients and service providers in provision of VMMC counseling and referral service.
There is evidence that the book was not widely distributed due to high printing and distribution costs. All recipients of text
messages said that they know nothing about the book and the never come across VMMC text book. However, they said they that
they dong think if they would feel comfortable reading the book on VMMC in public.
Development of text messages was preceded by information needs assessment where by people from the target groups and
other community members were invited in a meeting where they were asked about their opinion on VMMC services and why
people are not going for VMMC. Identified Issues, challenges and setbacks were used to develop text messages which were letter
on communicated back to the larger community. Identified issues which were letter on used to develop text messages includes
 Poor understanding of Voluntary Medical Male Circumcision (VMMC) (meaning and the procedure)
 Lack of knowledge on the importance of voluntary medical male circumcision.
 Community Myths and misconception about the service (VMMC)
 Adult men not feeling comfortable to be circumcised b women service providers
 Poor knowledge on the procedure (VMMC operation)
 Fear of adverse events post circumcision
 What to do and not to do before and after VMMC
Responding to Identified issues TAYOA worked with other partners to develop text messages covering the following topics.
Table 1 Number of Text Messages Developed on Different Topics

N Topic No of text Messages
Credits (source & Acknowledgement) 1
Definition of VMMC 1
Why VMMC and not the traditional circumcision 1
Benefits of VMMC 8
Myths and Misconception 5
Information on the actual procedure 2
Post Procedure wound care 7
HIV Prevention post Circumcision 1
Referral to other Services 1
VMMC is not about Genital mutilation 1
Source: Field Data, 2016
All text messages which were analyzed were developed responding to the SMS contents development guideline developed
by National AIDS Control Program (NACP) where by all text messages adheres to the following rules.

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Table 3 This Table is Copied from IEC Materials Reviewing Guide Showing Important Issues to Consider when Developing Text
Messages. The Third Column is not Part of the Original Table
Credits Source
e.g. You are receiving this message
Acknowledgement of authorities, stakeholders/partners and other
from the ministry of Health
individuals who participated in communication initiative.
Time and frequency When call text messages will be sent to intended audience e.g. Morning, Afternoon or night
How many times text messages will be sent to intended audience e.g. One SMS per week, everyday
Message contents Length (not more than 160 characters with spacing) 160 Characters
Validity (of information for both voice and SMS) Approved by the ministry
Easy to understand
Specific
Objective
Consistency
Gender issues/sensitivity
Source: IEC Modified by Author
 Is There Any Direct Relationship Between Mobile Text Messages and Uptake of Voluntary Medical Male Circumcision?
During interview and focus group discuss there are some features which were presented by all participants when they were
thinking about their experience with VMMC. 73% of individual who participated in this assessment remembered some
communication activities which were associated with VMMC campaigns. And 86% mentioned street banners and radio
promotions as what they remember the most about VMMC. Participants experience shows that there was ongoing discussion all
over the community about VMMC. However, they all acknowledged that despite of the situation many adults were not going for
VMMC
During focus group discussion one participant said “Sometimes, during night we were watching videos on HIV prevention
but they were not showing any videos on VMMC in their Cinema van”. This responds to the fact that parents and children were
going together for video shows therefore it was not even easy to discuss issues about VMMC in public since people in Shinyanga
consider any discussion on sexual reproduction health or sexuality as something which cannot be discussed in public.
“I remember in 2010 the major discussion was what is the different, do I need to go to hospital for circumcision while I can
get this service traditionally” one participant said during focus group discussion when asked about their experience with VMMC.
People were associating VMMC with bad government intention mostly ‘family planning’, “People were saying adult men who are
going for VMMC will not be able to make a woman pregnant” therefore adult men were discussing not to go for VMMC.
There are evidences that many adults were not going for VMMC because they thought the target for the campaign was
children, one participant said “My experience if different, many children from primary and secondary schools were going for
VMMC, and this was so boring, you go for the service then you find there is long ques and I cannot waste my time competing
with children in the que”. During interview we realised that primary school children were given some days off to go for VMMC
this resulted into high population of primary and secondary school students in VMMC service provision sites which in-turn
prohibited their brothers and fathers from going for the service.
 What do you Remember About Receiving Text Messages on VMMC?

Men who participated in this study were all subscribed in TAYOA’s SMS System to receive text messages on VMMC
between 2012 to 2014. During this study there were asked to say anything they remember about receiving text messages on
Voluntary Medical Male Circumcision (VMMC). Of 40 people who participated in study 2 participants said not to remember
anything about receiving text messages about VMMC in their mobile phone. However, they acknowledged receiving forwarded
messages form their peers and friends.
During follow-up we realised that, those who did not receive text messages their number were mis-captured when they were
coping from SMS subscription card to SMS system. All numbers (2) were not valid (active) phone numbers.
All participants remembered about filling in SMS subscription cards where by most of them remembered getting SMS
subscription card from village offices or during village meetings and others remembered receiving SMS Subscription cards from
form their peers and friends. All participants were aware of the fact that it is possible to subscribe to the SMS System by sending
the word ‘VMMC’ to 15017 as it was promoted but no one of the participant ever tried to subscribe.
Community leaders were also remembered by participants in this study. In program implementation community leaders were
considered to as popular opinion leaders who were used to influence people (adult’s men) to first subscribe in the SMS system by
filling SMS subscription cards and participate in the actual campaign. In this campaign community leaders were considered to as
popular opinion leaders who were used to Distribute and Collect SMS subscription cards. All participants remembered the role
played by community leaders in subscribing them in SMS system.

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Justification for using community leaders to distribute SMS subscription instead of using them for knowledge provision is
the fact that, in first place people were not comfortable discussing about VMMC in public, and community leaders were not
conversant enough about the service. Since community leaders were from the same community it was thought that they might
have the same myth and misconceptions about the service therefore using them to provide technical information is a such critical
situation was expected to cause more harm than benefits
Other participants remembered about receiving text messages every day, “I was receiving one text message every day, once
or twice I received two SMS per day” one participant said. During content analysis we realised that 29 text messages were
developed and TAYOA’s SMS system is configured to send one text message every day. The only time when the system had to
send more than text messages in when they were sending text messages on VMMC and text message on clinic appointment like
inviting subscribers to go for VMMC when service is available in their village or nearby village or sending an SMS to remind
them go for post operation check-up.
During focus group discussion one participant said “There were so many other people who were not subscribed to the SMS
system, I used to share text messages with them as I receive” when other people were asked if they remembered sharing text
messages with their peers and friends, 32 acknowledged sharing text messages. Only 8 participants said they never shared text
messages they received. “Other text messages were very interesting, especially those about misconceptions, kit was like there
were designed to respond to our discussion, I was not sharing all text messages, but I remember sharing every interesting text
messages.” Another participant said “it was not expensive to share text messages, I remember we were subscribing to telephone
bundles and were getting many free SMS, I don’t remember using all of them, you know it is not easy”
All participants said they wish they could receive more text messages on different health issues. “Why did you stopped
sending us text messages? You would have told us if there is anything we are supposed to do so as to continue receiving text
messages for free. I tried to subscribe to another SMS which was promoted in TV and they were taking money from my phone
every day and I was not aware on how to unsubscribe, I even thought of changing my number” one participant complained during
focus group discussion. All participant in this study presented to have bad experience with subscribing to SMS based service
(specifically using short codes).
 How Mobile phone text messages influenced your decision to go for VMMC?
There are evidence that text messages helped in increasing awareness about VMMC, its importance and effectiveness. “Like
me, before I started receiving text I was not even thinking of going for VMMC, imagine if you were you, would you opt to go for
VMMC at the age of 36?” One participant asked. Participants who were aged above 30 thought that it was too late to get
circumcised but awareness brought in by text messages made them think that it is important for them to go VMMC. For those who
were below 30 there were also feeling shy but receiving text messages made them aware of the fact that many people in their
communities are not circumcised and the service is tailored to target adult men.
One of the biggest challenge which was solved by text messages according to participants is appointment setting. “I decided
to go for the service after receiving the text message telling me that if I show my text message to service providers I will be given
a priority and I don’t need to follow the que if I have an appointment SMS” One participant said. During an interview one
participant said “It is not easy standing in a que with your son’s and uncles waiting for the service, it’s a shame, sometimes they
don’t think if we not yet circumcised, I remember my text message allowed me to enter through the backdoor and I was asked few
questions to test if I know each and everything about circumcision”
Text messages helped recipients to make an informed decision to go for the service by clearing myths and misconception
which were limiting adult men to go for the service. For example, many adult men were not going for the service fearing of
delayed healing and some of them were not going for service because they were told that they will not be able to get children after
circumcision. “After knowing the benefits and answers for almost all myths which were in the community I decided to go for the
service” One participant said.
Text messages helped partners to discuss about the crevice and decide together. In some circumstances even were subscribed
to receive text messages on VMMC and Men who were receiving text messages were also sharing received text messages with
their partners (sexual Partners). There are evidence that men who were in relationship (who were the major target of the service
were not going for the service because they knew that they had to abstain from sex for six weeks’ period. The challenge with this
requirement for men they were thinking that their partner (women) will not be able to abstain for six weeks therefore there is a
likelihood that they will start cheating. Research results proves that women who were receiving text messages were more
supportive to their partners during VMMC as compared to those who were not receiving text message.
Women who were not receiving text messages were also asking their partners not to go for VMMC while those who were
receiving text messages they also escorted their partners to the service. Text messages were also communicating other benefits
which female partner will get if the man is circumcised including HIV Prevention and reducing the risk for cervical Cancer. If not
for text messages women would not have supported and sometime forced their partners to go for the service.

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 Do you think if it’s not for mobile phone text messages you would you have gone for VMMC?
During this study, participants were randomly asked if they would have gone for the service without receiving text messages.
Since people had different opinions they proposed for voting where by 11 (27%) participants said its true that text messages
helped them to increase knowledge about the service but they were planning to go for the service even before receiving text
messages. However most of them said that text messages made it easy for them to decide to go for the service “I would have gone,
receiving text messages fastened my decision” one participant said.
27 participants (68%) said if not for SMS they would not have gone for the service. “Why do you think this is easy decision
to make? One participant asked. “Imagine at my age going for circumcision, it is not easy and it is not supposed to be easy, may
be it is because you are not in our community, sometime you may find even your wife laughing at you because you want to go for
circumcision at this age, sure am telling, if you investigate you will find many people (adult) were not circumcised but if you ask
they will say they are already circumcised, nowadays thinks have changed people feel shame when they are not circumcised.
Honestly receiving text messages made me go for VMMC.
“Text messages changed many things, perception, knowledge and most important thing is that many people in our
community were receiving text messages therefore it changed the way everyone in the community is thinking about VMMC. At
least we had something to share and talk about”
Only 2 participants who were not sure if receiving text messages made them decide to go for VMMC are the ones their
numbers were wrongly added in the SMS system. However, they all acknowledged receiving forwarded text messages on VMMC
from their friends.
Fig 1 People’s Opinions on how Receiving Text Messages Contributed into Their Opinion to go for VMMC
Speaking to one older participant he said he used to see mobile video in the evening, but he was not persuaded to for the
service since videos they were showing were not telling anything about VMMC. The man said, it is text messages that made him
decide to go for the service he also suggested that text messages be used for other interventions.
Another man said that he knows men his age was not going for the service because they had to arrive early in the morning as
they live far from the VMMC service points, so for text messages to help them being given priority entry was very important and
this it easy for many adult men to go for VMMC. “I think if it not for SMS many adult men would not have gone for the service”
One participant said.
 How Mobile Phone Text Messages Changed Community Perception on VMMC?
 Do you think text messages addressed any challenges with VMMC in your society? How?
All participants in this study acknowledged the fact that text messages addressed many social challenges which were
prohibiting adult men from going for the service. Text messages has been able to tackle all local myths and social norms. For
example, the traditional circumcision versus voluntary medical male circumcision and the myths that after being circumcised it is
important for the man to go and have sex to prove he is “okay” and the quickest route to do this was to visit a prostitute.

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Other myths and misconceptions were limiting people from going for the service and this is because people in the
community were not discussing about VMMC. Text messages helped to stimulate discussion in the community and people started
to talk about myths and misconception around VMMC. Sharing of text messages also helped people who are not receiving text
messages directly from SMS system to be aware of the service and knowing the truth about VMMC.
“We had the perception that adult men may not be able to perform sex as it was before circumcision, this worried both men
and women. Text messages helped us to understand the fact that there is no connection between sexual performance and VMMC.”
One participant said. People were asking I’ve been having sex without being circumcised, why is it important for me now? Text
messages helped people to know why it was important.
 Does anyone else have some thoughts on mobile phones text messages and VMMC?
“Information which were communicated thought text messages can hardly be communicated by any other means, for
example after being circumcised I received text message informing me that I am supposed to abstain for six weeks. Before that we
had a perception that we can resume sex as soon as we are feeling good post circumcision” “knowing that we are supposed to
abstain for six weeks is important but it is not easy to abstain for six weeks, the good thing with text messages is that they were
telling us why it is important to abstain”
Text messages changed the way people were thinking about the service, particularly adult men. Before text messages parents
were sending their children for circumcision they were not thinking of VMMC as something important for adult men. “It is text
messages that helped us to know that it is important for us to get circumcised, I think it was important for adult than it was for
children because they are not at risk as we are”
Before text messages women were not supporting their adult partner to go for VMMC. Responding to benefits
communicated through text messages women started to support to their partners because they were aware of the fact that VMMC
is important not only for men who are going for circumcision but also for them.
Text messages also helped to change the perception that when someone is circumcised cannot get HIV. Since VMMC was
promoted as protective measure against HIV people were thinking that when they are circumcised they cannot get HIV. “I was so
disappointed to know that circumcision decrease the chance only and 100%protection, in my opinion communicating this fact was
very important”. It is evident that if this information was not communicated circumcision would have caused increased HIV
infections than decreasing infections.
C. Chapter Summary
The study, in which the effectiveness of mobile phone text messages in increasing uptake of voluntary medical male
circumcision were being accessed, has proved that mobile phone text messages are effective especially in interventions where
issues that needs to be communicated cannot be shared through mass media. The focus telephone focus group discussion and
interviews provided an insight into the participants’ views on VMMC text message. Discussions helped to measure other issues
related to effectiveness of communication like memorability, ability to prompt actions. In this study interviews were of great
important since it provided researcher with crucial insights into individuals’ interpretations and perceptions of text messages in
relation to VMMC. The collection of data form of a telephone focus group discussion helped participants to freely talk without
fear of being known. The qualitative nature of the survey enabled the collection and analysis of data on a large scale

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CHAPTER FIVE
SUMMARY OF FINDINGS, DISCUSSIONS, CONCLUSION AND RECOMMENDATIONS
A. Introduction to the chapter
This chapter provides a discussion of the findings obtained from content analysis, Interviews and focus group discussion
during data collection phases. The chapter will highlight a number of parallels that can be drawn between mobile phone text
messages and VMMC service uptake.
Here the findings of the study are correlated with each of the three research questions presented in chapter one. After a
brief review of the questions and the researcher’s predictions as far as possible outcomes, results are discussed, including
interpretations that attempt to provide logical explanations. Interpretations of the data are offered together with a comparison of
empirical findings to the relevant literature.
This chapter also provides a set of broad conclusions and demonstrate how the aims and objectives, as introduced in
Chapter 1, have been addressed throughout the thesis. Contributions to the field of studies and recommendations for future
research are presented and discussed.
B. Discussion
Findings from this study proves that there is a close relationship between behavior change and service uptake. It is evident
that text messages helped in increasing knowledge about VMMC and the knowledge gain helped people in Shinyanga to change
their attitude toward the service. It is also true that socially constructed realities. People had their own society had its own
definition of the service, notions, or connotations that were assigned to the service. Constructed realities were natural and obvious
to members of the society but those realities were not representing the reality (Gergen 1985). Most of them were myths and
misconceptions which were letter on cleared by text messages.
Since all aspects of humanity are created, maintained and destroyed in our interactions with media and others through time
(Watzlawick, 1984) Text messages about VMMC which were sent contributed in destroying socially constructed realities about
voluntary medical male circumcision.
Referring to The Health-Belief Model (Rosenstock, Strecher, & Becker, 1988) this research has proved that beliefs are the
core of health behavior. People in Shinyanga had their own beliefs that VMMC is not important for them, there is a bad intention
behind the service they developed their own understanding of the service and this limited them form going for the service. it is
evident that beliefs are explains why some people engage in preventive health behaviors like voluntary medical male circumcision
and others do not. Text messages which were sent helped in increasing awareness about the service and it is through this
awareness where people changed beliefs and decided to go for the service.
It is also true that mobile phone text messages facilitated the decision making process. This fact responds to the Common-
Sense Model (Leventhal, 1970) people actively engage in problem-solving by developing mental models of health threats,
subjective and objective treatment goals, and practices and procedures most likely to achieve those goals. As it was found during
data analysis many people were aware of the service and they were ready to go for it but there were many barriers which were
limiting them from going for the service, this means that they were looking for good reason to go for the service.
During content analysis it was realized that text messages were developed to promote individual’s intentions to go for the
service (VMMC) by defining the service and clearing myths and misconceptions. The fact there were some text messages which
were developed to communicate benefits proves that text messages were purposely developed to provide its recipient with reasons
to why they are supposed to go for the service. As it is explained in chapter two this is Cleary linked with the theory of reason
action (Ajzen & Fishbein, 1980; Fishbein & Ajzen, 1975) which posits that behaviors are directly dependent on intentions (based
on the observation that people’s attitudes are not always good predictors of actions), and that intentions are influenced by attitudes
(emotion/feeling overlaid on beliefs) and subjective norms (perceptions about what others think, and degree to which it matters
what others think). Since developed text messages were able to increase knowledge and influence attitude it is evident that
communicated messages were effective
Text messages were developed to create motivation. For example, other text messages were communication what people will
get if they decide to go for the service one text messages consisted of the fact that VMMC provides 60% percent protection
against HIV and another messages were about the fact that circumcised men reduces the chances of transmitting cervical cancer
causing virus to female partner. The Theory of planned behaviour (TPB) (Ajzen, 1985, 1987) proves that there were higher
chances for demand creation campaign by using to be successful since text messages were motivating (intention) and providing
people with ability (behavioural control) to go for VMMC.

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There were many text messages, SMS system is designed to send one text messages per day. In this study this finding had a
very significant logic. Text messages were deigned to move recipients from one stage to another as it is clearly explained in
Trans-theoretical Model (TTM) (Prochaska & DiClemente, 1982), text messages were designed and sent in a way that they were
taking an individual through a series of stages from pre-contemplation (not yet even considering to go for VMMC) to action and
maintenance (when people are already circumcised and they are informed that they are supposed to continue abstaining from sex
for another six weeks even if they feeling good).
Fig 2 Trans-Theoretical Model
Research findings from group discussion and interviews proves that text messages were not only providing information but
they were also providing motivation and helping to address structural barriers which were limiting people from accessing the
service. This finding is supporting Information-Motivation-Strategy Model where which assert that provision of any one or two of
these elements is insufficient; all elements are essential. An individual may understand the importance to go for the service
perfectly but have little interest in carrying it out; or the individual might understand and be highly motivated but experience in
surmountable barriers to effecting change. This happened for people who were receiving text messages since even when they were
ready to go for the service they were not ready to stand in a long que, However SMS helped them with setting an appoint and thus
motivating adult men to go for VMMC.
In health communication, disease prevention and control, the health impact of campaigns is usually measured in the form of
increased knowledge and service uptake. Using text messages has proved to be effective since it results from contents analysis,
focus groups discussion and interviews proved that there were an increasing knowledge and service uptake not only among SMS
recipients but also among other members of the society. Evaluating effectiveness of mobile phone text messages measuring
variables like knowledge, attitude and behavior as a means of assessment evaluation (Coffman J. 2002, Bauman A, at al 2006)
The fact that participants were able to recall messages and link received text messages with behavior three years later is also
an evidence that the communication initiatives was effective (Evans W, at al, 2009), Things like message recall and recognition,
attitudinal correlates of targeted behavior, social norms, intentions to change, and behavior change are often chosen as they are
predictive of longer term behavior changes as outlined by theories of behavior change such as the Theory of Planned Behavior
(Ajzen I, 1980). Other short term measures of effectiveness of campaign are reactions to campaign materials, likeability or
perceived message effectiveness, these are common but less informative in terms of actual campaign effectiveness as they lack a
strong theoretical basis (Evans W, at al, 2009).
Campaign exposure is a key outcome examined in most effectiveness assessments studies as various levels of exposure to
mobile phone text messages can be linked with varying levels of effectiveness such as a service uptake. The significance of
Campaign exposure as an outcome measure, however, is often open to discussion, as quite often it is measured by self-reporting,
which may have questionable reliability (Coffman J, at al 2002) Process evaluation may aim to track campaign implementation by
examining frequency of message distribution regarding the specific media channel (Coffman J, at al 2002).
C. Conclusion
The scope of this conclusion is limited to the context in which mobile phone text messages were developed and shared to
people living in Shinyanga region to create demand for voluntary medical male circumcision among adult men. Thus, applied to
other situations, these conclusions may yield incorrect assumptions. Still, this conclusion is relevant to the process of assessing the
effectiveness of mobile phone text messages in increasing uptake voluntary medical male circumcision in Shinyanga.
While this study acknowledges again the effectiveness of mobile phone text messages in increasing uptake of voluntary
medical male circumcision, it shows how important it is for text messages to address real challenges and for the text messages to
address real challenges baseline assessment is important.

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In health intervention communication initiatives are designed and launched to create demand for the service, create
awareness and sometime promote positive behavior change, at the end they are supposed to produce certain desirable outcomes
and meet specific expectations. However, conditions prevailing in this campaign and strategies that were introduced to increase
the uptake of voluntary medical male circumcision affected the outcome in many different ways.
This study showed how contextual characteristics of VMMC service provision, as well as cultural barriers and social
perception, affected adult men uptake of the service. However, it is important to recognize that there are other variables beyond
mobile phone text messages that contributed into increased uptake of VMMC which were not included within the scope of this
research (TV Advertisements, Street banners, radio promotions, education and Health service availability.
The findings of this research add modestly to the body of knowledge of literature on using mobile phone text messages to
communicate health issues. Due to its nature (personal) the use of mobile phone text messages is becoming a major means of
communication in health communication. Simple facts such as knowing how effective are the text messages when used to create
demand for health service over time it can be the basis for more assertive actions supporting or enforcing progressive use of
mobile phone text messages in other service demand creation beyond health. Understanding the effectiveness of mobile phone text
messages, the process of developing mobile phone text messages and using them to create demand for the service would be an
effective way to promote health services and increase health behaviors in developing countries like Tanzania.
D. Recommendations
The use of mobile phone text messages in health service have been the topic of much discussion in the health communication
field, Mass Communication studies, advertising agencies and advertisers but little has been done to study their effectiveness on
subscribers and in meeting communication objectives. It is true that our world is more mobile now than ever, Consumers/target
audience are always on the move and it is increasingly hard to reach them through traditional channels like TV, Radio and
newspapers. Tanzania communication regulatory authority (TCRA) reports proves that there is an increasing penetration of
mobile phones to the most rural areas, mobile networks cover more than 75% of the country population. Availability, affordability
and ubiquity make the mobile phone text messages an essential platform for health communication.
The increasing use of mobile phones makes it important for researchers to conduct more research on how communicators
can use this opportunity in promoting health service. mobile phone has become the new “must have” for any serious “innovative”
communication campaign. In Tanzania for example there are more than 29 million mobile phone users (TCRA Report December
2015) All these phones have built-in SMS capability.
Opportunity to get feedback from SMS recipients was misused since the organization (TAYOA) did not use the opportunity
to collect feedback via SMS. It seems that interactive SMS campaigns are important in the future research because they allow
organizations to engage populations in interactive dialogue, to improve the service and learn from communication initiatives
mistakes. TAYOA would have used this interactivity as a feedback mechanism; asking people how useful the campaign has been
via SMS
According to study findings it is worth to recommend that, although mobile phone text messages is a new phenomenon in
Tanzania already there is a need to have established ethical guidelines to control performance and usage of mobile phone text
messages. This is due to the fact that people who receive text messages believe in information they receive and they use it as a
reference information even when text messages are not from authenticated sources. To avoid deceptiveness of mobile phone text
messages there is a need for providers of SMS services though SMS short codes make sure that they provide subscribers with all
important information, including how to unsubscribe and costs (if any) It is also important for the source of SMS to be open e.g.
‘You receiving this message from ………’
It is recommended for program planners and implementers to make sure that they collect baseline data so as to help
communicators to measure the change communication campaigns can bring over time. With the SMS campaign we were assessing
it was easy to know if changes were happening because routine data collected were giving s clear picture that adult men were not
going for the service.
 Recomendations and Suggestions for Further Research

This study focus was mainly on people who received text messages. It Is important for further research to focus on
comparing knowledge and altitude between those who received text messages and those who did not. Response from this study
focus group discussion, and interviews makes it interesting to involve others from the same community who were not receiving
text messages. further studies also should focus on measuring the actual knowledge on issues which were communicated.
Further studies should include all key players in a communication cycle. For example, in our case this research would have
involved The Ministry of health, IntraHealth, community leaders, female partners and target audience, this may help in coming
out with another kind of research which will be more objective and representative rather than dealing with only one player in
advertising pie.

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APPENDICES
APPENDIX I: FOCUS GROUP DISCUSSION

Thank you for agreeing to participate. I am very interested to hear your valuable opinion on effectiveness of mobile phone
text messages in uptake of voluntary medical male circumcision in Shinyanga.
 Introduction
 The purpose of this study is to learn how text messages influenced subscriber’s decision to go for VMMC
 The information you give me is completely confidential, and we will not associate your name with anything you say in the
focus group
 I would like to tape the focus groups so that we can make sure to capture the thoughts, opinions, and ideas we hear from the
group. No names will be attached to the focus groups and the tapes will be destroyed as soon as they are transcribed
 You may refuse to answer any question or withdraw from the study at anytime
 We understand how important it is that this information is kept private and confidential. We will ask participants to respect
each other’s confidentiality
 The Process
 We learn from you (positive and negative)

 Not trying to achieve consensus, we’re gathering information
 No virtue in long lists: we’re looking for priorities
 In this study, we are doing both Interview and focus group discussions. The reason for using both of these tools is that we can
get more in-depth information from a smaller group of people in focus groups. This allows us to understand the context
behind the answers given in the interview and helps us explore topics in more detail
 Guiding Questions
 Let’s start the discussion by talking about your experience with VMMC.
 What do you remember about receiving text messages on VMMC?
 What are some things that were not good with VMMC?
 Do you think text messages addresses any challenges with VMMC in your society? How?
 Do you think if it’s not for mobile phone text messages you would have for VMMC?
 What else influenced your decision to go for VMMC?
 Does anyone else have some thoughts on mobile phones text messages and VMMC?

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APPENDIX II: INTERVIEW GUIDE FOR SMS RECIPIENTS
My name is (interviewer name) I am calling from Dar es salaam I got your number from Health Mobile phone text
messaging system. Before I proceed I would like to know if you are in the position to answer my questions now. Yes__________
No__________
(if No thank him/her and hang-up. If yes continue to questions)
As one of recipient of mobile phone text messages on VMMC, you are invited to participate in a research where we
want to know to know if mobile phone text messages contributed in increased uptake of voluntary medical male circumcision
among sexually active adult men aged between 19 -49 in Shinyanga region, we also want to learn what was communicated
through text messages and learn how text messages recipients changed their perception toward VMMC after receiving text
messages.
This study will help us better understand how mobile phone text messages helped people to make decisions about their health.
e.g., Is there any direct relationship between mobile text messages and uptake of voluntary medical male circumcision? What kind
of mobile phone text messages were communicated? How mobile phone text messages changed community perception of
VMMC. The discussion will not take more than an hour and it will be recorded. Information about you will remain confidential.
This study does not involve any type of physical risk; the information you provide will be kept strictly confidential. To
protect your privacy, your responses to the interview questions will only be identified with a code number. The decision to
participate in this research project is entirely up to you. You may refuse to take part in th e study without affecting your
relationship with anyone. You may also choose not to answer any question posed. Your decision will not result in any loss or
benefits to which you are otherwise entitled.
Interviewer Name: __________________ Date: __________________ Time: __________________
 Demographic info
 Age
 Sex
 Level of education
 Marital status
 Residence (region and district)
 Interview Guiding Questions
 Let’s start the discussion by talking about your experience with VMMC.
 What do you remember about receiving text messages on VMMC?
 What are some things that were not good with VMMC?
 Do you think text messages addresses any challenges with VMMC in your society? How?
 Do you think if its not for mobile phone text messages you would have for VMMC?
 What else influenced your decision to go for VMMC?

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APPENDIX III: TEXT MESSAGES WHICH WERE COMMUNICATED
 Target Audience; Men & Boys

\
 Habari, Utakuwa ukipokea ujumbe kuhusu tohara bila malipo. Ujumbe huu unaletwa kwako na Wizara ya Afya na ustawi wa
jamii kwa kushirikiana na asasi ya TAYOA.
 Elewa kuwa tohara ya mwanaume ni ukataji wa ngozi inayofunika kichwa cha uume. Ni kitendo ambacho kimekuwepo toka
zamani kwenye baadhi ya mila na desturi
 Unajua kuwa tohara salama hutolewa na watoa huduma za afya katika mazingira rasmi kama vituo vya afya na vituo vya muda
vya huduma? Nenda katahiriwe sasa
 Fahamu kuwa tohara ya mwanaume hupunguza uwezekano wa kupata maambukizi ya Virusi vya UKIMWI (VVU) kwa
asilimia hadi 60. Katahiriwe sasa.
 Tohara hupunguza uwezekano wa kupata baadhi ya magonjwa yaenezwayo kwa njia ya ngono kama vile Kaswende. Fanya
maamuzi sahihi sasa, Nenda kafanyiwe tohara
 Fahamu kuwa, tohara ya mwanaume inarahisisha usafi wa uume, inasaidia kumkinga mtu dhidi ya saratani ya kichwa cha
uume na inarahisisha uvaaji wa kondomu.
 Unafahamu? Kama ukifanyiwa Tohara utapunguza uwezekano wa mwenzi wako wa kike kupata saratani ya mlango wa
kizazi? Mkinge mwenzi wako kwa kufanyiwa Tohara
 Ukweli ni kuwa wakati wa tohara unaweza kupata maumivu na kutokwa damu kidogo, hata hivyo watoa huduma hutoa dawa
za maumivu na kudhibiti kutokwa na damu.
 Kumbuka, Ukishatahiriwa unapaswa kuendelea kujikinga dhidi ya VVU kwa kutofanya ngono, kuwa mwaminifu kwa mwenzi
wako na tumia kondomu kila unapofanya ngono
 Kwa kawaida, huduma ya tohara hujumuisha ushauri nasaha na upimaji wa hiari wa VVU kabla ya tohara. Unashauriwa kuja
na mwenzi wako ili mpime pamoja.
 Kwa utaratibu, huduma ya upimaji wa VVU hutolewa bila malipo, Utaongea na mshauri nasaha kabla na baada ya kupima.
Utapata majibu ndani ya dakika 20
 Tohara ni muhimu hata kama umeambukizwa VVU. Kama ukipimwa na kukutwa na VVU utapata ushauri nasaha na kupatiwa
huduma ya tohara kama kawaida.
 Ukweli ni kuwa tohara ya mwanaume haipunguzi wala kuongeza nguvu za kiume. Tohara hupunguza hatari ya mwanaume
kupata maambukizi ya VVU.
 Si kweli kuwa watoa huduma za afya wa kiume pekee ndio wenye uwezo wa kufanya tohara, Tohara inaweza kufanywa na
mtoa huduma za afya bila kujali jinsi.
 Sio kweli kwamba tohara inasababisha utasa na kupunguza raha ya ngono. Ukweli ni kuwa tohara haisababishi utasa na wala
haipunguzi raha ya ngono.
 Si kweli kwamba, watu wenye umri mkubwa huchelewa kupona vidonda vya tohara. Ukweli ni kuwa kidonda huanza kupona
ndani ya siku 7 na huchukua wiki 6 kupona kabisa
 Kwa kawaida, Tohara hufanywa na watoa huduma wa afya kwenye chumba maalumu chenye vifaa safi. Hii husaidia kuzuia
uwezekano wa kuambukizwa magonjwa mengine.
 Kumbuka, Baada ya tohara utapumzika kwa dakika 30 kisha utaruhusiwa kurudi nyumbani na utapaswa kurudi tena baada ya
siku moja au mbili uangalizi wa awali
 Jua kuwa, Tohara hufanywa ndani ya dakika 30. Kwanza uume husafishwa na kuchomwa sindano ya ganzi kuzuia maumivu.
Baada ya tohara uume hufungwa kwa bandeji
 Zingatia kwamba, baada ya tohara unapaswa kutofanya kazi ngumu kwa siku 3 na hakikisha kuwa haufungui bandeji mpaka
unaporudi kituo cha huduma ya tohara.
 Hakikisha kwamba, sehemu iliyofanyiwa tohara inatunzwa na kuwa kavu kwa siku 3. kumbuka kuwa mwangalifu ili
kutolowanisha eneo lililofungwa bandeji
 Kumbuka,hata baada ya kutolewa bandeji unapaswa kutoweka dawa yoyote kwenye eneo la uume. Ikibidi jisafishe taratibu
kwa sabuni ya kawaida na maji safi
 Ukweli ni kuwa, Uvimbe mdogo kwenye uume, kuongezeka hisia za ngono na kutojisikia vizuri ni kawaida baada ya tohara.
Hali hii huisha baada ya muda mfupi
 Kuwa makini, ukiwa na maumivu makali, Kuongezeka kwa uvimbe, kutokwa na damu au uchafu katika uume baada ya
tohara. Nenda kwenye kituo cha huduma za afya
 Kumbuka, Haupaswi kufanya ngono au kupiga punyeto katika wiki 6 za kwanza baada ya tohara ili kuruhusu kidonda kupona
kabisa.
 Zingatia, Iwapo mwanaume aliyefanyiwa tohara atafanya ngono wakati kidonda hakijapona atakuwa kwenye hatari kubwa
zaidi ya kupata VVU na magonjwa ya ngono
 Usisahau kwamba, Hata baada ya tohara ni muhimu kutumia kondomu kwa usahihi ili kupunguza hatari ya kupata
maambukizi ya VVU.

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 Una swali? tatizo au unataka kujua zaidi kuhusu tohara? Piga simu bila malipo kwenda namba 117 kila siku kuanzia saa 6
mchana hadi saa 6 usiku
 Kumbuka, Tohara inayoshauriwa kisayansi na kisheria ni ile inayofanywa kwa wanaume. Tohara kwa wanawake haikubaliki,
ni ukatili na ni kinyume cha sheria
 Target Audience; Women
 Habari, Utakuwa ukipokea ujumbe kuhusu tohara bila malipo. Ujumbe huu unaletwa kwako na Wizara ya Afya na ustawi wa
jamii kwa kushirikiana na asasi ya TAYOA.
 Elewa kuwa tohara ya mwanaume ni ukataji wa ngozi inayofunika kichwa cha uume. Ni kitendo ambacho kimekuwepo toka
zamani kwenye baadhi ya mila na desturi
 Fahamu kuwa tohara ya mwanaume hupunguza uwezekano wa kupata maambukizi ya Virusi vya UKIMWI (VVU) kwa
asilimia 60. Jadili na mwenzi wako akafanyiwe tohara.
 Tohara salama hutolewa na watoa huduma za afya katika vituo vya huduma za afya na vituo vya muda vya huduma ya Tohara
 Tohara hupunguza uwezekano wa kupata baadhi ya magonjwa yaenezwayo kwa njia ya ngono kama vile Kaswende. Mshauri
mwenzi wako ili akatahiriwe
 Kama mwenzi wako akitahiriwa itarahisisha usafi wa uume, inasaidia kumkinga mtu dhidi ya saratani ya kichwa cha uume na
inarahisisha uvaaji wa kondomu.
 Unajua kuwa Kama mwenzi wako atafanyiwa tohara atakuwa amepunguza uwezekano wa wewe kupata saratani ya mlango
wa kizazi? TOHARA YA MWANAUME NI MUHIMU KWAKO PIA
 Tohara haisaidii kupunguza uwezekano wa maambukizi kutoka kwa mwanaume aliyeambukizwa VVU kwenda kwa mwenzi
wake. Hivyo ni muhimu kutumia kondomu
 Kumbuka, Mwenzi wako wa kiume alietahiriwa anaweza kupata maambukizi ya VVU iwapo atashiriki tabia hatarishi kama
kutotumia kondomu au kuwa na wapenzi wengi.
 Unajua kuwa huduma ya tohara ya mwanaume hujumuisha ushauri nasaha na upimaji wa hiari wa VVU? Jadili na mwenzi
wako ili mpime pamoja kabla ya tohara
 TAARIFA, Huduma ya upimaji wa VVU hutolewa bila malipo, mtapata nafasi ya kuongea na mshauri kabla na baada ya
kupima. Majibu hutolewa ndani ya muda mfupi
 Ukweli ni kuwa tohara ya mwanaume haipunguzi wala kuongeza nguvu za kiume. Tohara hupunguza hatari ya mwanaume
kupata maambukizi ya VVU.
 Si kweli kuwa watoa huduma za afya wa kiume pekee ndio wenye uwezo wa kufanya tohara, Tohara inaweza kufanywa na
mtoa huduma za afya bila kujali jinsi.
 Sio kweli kwamba tohara inasababisha utasa na kupunguza raha ya ngono. Ukweli ni kuwa tohara haisababishi utasa na wala
haipunguzi raha ya ngono.
 Si kweli kuwa watu wenye umri mkubwa huchelewa kupona baada ya tohara. Ukweli ni kuwa kidonda huanza kupona ndani
ya siku 7 na huchukua wiki 6 kupona kabisa
 Kumbuka kwamba, Baada ya tohara mwenzi wako atapumzika kwa dakika 30 kisha ataruhusiwa kuondoka na atapaswa kurudi
baada ya siku moja au mbili kwa uangalizi
 Fahamu, Baada ya tohara mwanaume anapaswa kutofanya kazi ngumu kwa siku 3 na kuhakikisha kuwa hafungui bandeji
mpaka anaporudi kituo cha huduma ya tohara.
 Hakikisha eneo lililofanyiwa tohara linatunzwa na kuwa kavu kwa siku 3. Saidia uangalizi wakati wa kuoga ili kutolowanisha
eneo lililofungwa bandeji
 Kumbuka kuwa, hata baada ya kutolewa bandeji mwenzi wako hapaswi kupaka dawa yoyote ile. Ikibidi ajisafishe taratibu kwa
sabuni ya kawaida na maji safi
 Fahamu kuwa, Mwenzi wako hashauriwi kufanya ngono katika wiki sita za kwanza baada ya tohara. Ili kuruhusu kidonda
kupona kabisa.
 Endelea kuwa mwaminifu kwa mwenzi wako katika kipindi cha wiki 6 baada ya Tohara. Kufanya ngono wakati huu kunaweza
kurahisisha maambukizi ya VVU
 Iwapo mmoja wenu ana VVU, kuna uwezekano mkubwa wa kumuambukiza mwenzi wake iwapo mtafanya ngono kabla ya
kidonda kupona kabisa. Chukua tahadhari
 Hata baada ya wiki 6 za mwanzo mnapaswa kuendelea kuwa waaminifu au kutumia kondomu kwa usahihi mara zote ili
kupunguza hatari ya kupata maambukizi ya VVU.
 Una swali? tatizo au unataka kujua zaidi kuhusu tohara ya mwanaume? Piga simu bila malipo kwenda namba 117 kila siku
kuanzia saa 6 mchana hadi saa 6 usiku
 Kumbuka, Tohara inayoshauriwa kisayansi na kisheria ni ile inayofanywa kwa wanaume. Ukeketaji haukubaliki, ni ukatili na
ni kinyume cha sheria

ISSN No:-2456-2165
 Reminders
 Kuanzia Kesho tar 30.04.2014 huduma ya TOHARA itakuwa ikitolewa bila malipo katika zahanati/kituo karibu na unapoishi.
Tafadhali fika bila kukosa
 Unakumbuka kuhusu uwepo wa huduma ya TOHARA LEO? Watu wenye ujumbe huu na wale wenye umri wa miaka 20 na
zaidi watapewa kipaumbele. Tafadhali fika bila kukosa.
 Kwa sasa huduma ya tohara inaendelea kutolewa bila malipo kwenye kituo cha afya karibu na unapoishi. Tafadhali fika bila
kukosa
Fig 3 Young Boys Escorted with Their Mothers Waiting for VMMC Service in One of the Service Provision Site in Shinyanga
(Before Mobile Phone Text Messages)
Fig 4 Adult Men Waiting for VMMC Service after Receiving Text Messages in Their Mobile Phones

Effectiveness of Mobile Phone Text Messages in Uptake of Voluntary Medical Male Circumcision in Shinyanga Region

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Effectiveness of Mobile Phone Text Messages in Uptake of Voluntary Medical Male Circumcision in Shinyanga Region

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Volume 8, Issue 10, October – 2023 International Journal of Innovative Science and Research Technology

Effectiveness of Mobile Phone

A Dissertation Submitted to the Department of Journalism and Mass Communication St.

IJISRT23OCT1440 www.ijisrt.com 1893

Dr. Joyce Bazira (PhD)

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Signature: ………………………… Date: ………………………………………….

Benedicto Luvanda (MAMC 50271/2016)

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AIDS: Acquired Immunodeficiency Syndrome

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A. Introduction to the Chapter

B. Backgrounds of the Study

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C. Statement of the Problem

D. Objectives of the Study

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F. Significance of the Study

G. Limitations of the Study

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B. Definition Of The Key Terms

C. Situating the Research within the Field of Health Communication

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D. Review of Relevant Theories

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E. Previous Research on the Topic

 Mobile Phone Text messages

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 Assessing Effectiveness of Communication in Health.

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F. Rationale for the Study

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B. Approach to the Study

C. Area of the Study

E. Sample and Sampling Technique

F. Data Collection Methods

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H. Validation of Research Instruments

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B. Presentation of the Research Findings

 What Kind of Mobile Phone Text Messages Were Communicated?

Table 1 Number of Text Messages Developed on Different Topics

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 What do you Remember About Receiving Text Messages on VMMC?

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 How Mobile Phone Text Messages Changed Community Perception on VMMC?

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Fig 2 Trans-Theoretical Model

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 Recomendations and Suggestions for Further Research

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Interviewer Name: Date: Time: __