UNIVERSITY OF ECONOMICS INSTITUTE OF SOCIAL STUDIES HO CHI MINH CITY THE HAGUE VIETNAM THE NETHERLANDS VIETNAM - NETHERLANDS PROGRAMME FOR M.A IN DEVELOPMENT ECONOMICS QUALITATIVE ANALYSIS OF SEXUAL HEALTH PROTECTION BEHAVIOR BY INCOME – THE CASE OF HO CHI MINH CITY BY LE THI PHUONG THAO MASTER OF ARTS IN DEVELOPMENT ECONOMICS HO CHI MINH CITY, OCTOBER 2012 1 TIEU LUAN MOI download : skknchat@gmail.com UNIVERSITY OF ECONOMICS INSTITUTE OF SOCIAL STUDIES HO CHI MINH CITY THE HAGUE VIETNAM THE NETHERLANDS VIETNAM - NETHERLANDS PROGRAMME FOR M.A IN DEVELOPMENT ECONOMICS QUALITATIVE ANALYSIS OF SEXUAL HEALTH PROTECTION BEHAVIOR BY INCOME – THE CASE OF HO CHI MINH CITY A thesis submitted in partial fulfilment of the requirements for the degree of MASTER OF ARTS IN DEVELOPMENT ECONOMICS By LE THI PHUONG THAO Academic Supervisor: DR. PHAM KHANH NAM HO CHI MINH CITY, OCTOBER 2012 2 TIEU LUAN MOI download : skknchat@gmail.com Table of Contents Chapter 1 : Introduction. 10 Chapter 2 : Literature reviews .1 Theory of Planned Behavior. 16 Chapter 3 : Research backgrounds and research methodology .4 Participants and studied location…………………………………………….
32 Chapter 4 : Empirical results .1 Description of variables .1 Attitude and perception…………………………………………………….3 Perceived Behavior Control…………………………………………………41 4.2 Determinants of sexual health protection behavior .1 Attitude/perception and sexual health protection behavior………………….2 Subjective Norms and sexual health protection behavior………………….3 Perceived behavior control and sexual health protection behavior…………. 49 3 TIEU LUAN MOI download : skknchat@gmail.com Chapter 5: Conclusions and policy implication. 63 4 TIEU LUAN MOI download : skknchat@gmail.com Table of Figures Figure 1: Theory of Planned Behaviour. 20 Figure 2: The layer of needs.
26 Figure 3: The collages of NeedScope model. 28 5 TIEU LUAN MOI download : skknchat@gmail.com List of Tables Table 1: Sample information. 30 Table 2: Attitudes and Perception variable. 43 Table 3: Subjective Norms variable.
43 Table 4: Perceived Behavioural Control variable. 44 Table 5: Behaviour variable. 44 6 TIEU LUAN MOI download : skknchat@gmail.com Abbreviations A&P Attitudes and Perception EC Emergency Contraception FDG Focus discussion group HCMC Ho Chi Minh city HIV/AIDS Human Immunodeficiency Virus/ Acquired Immunodeficiency Syndrome IDI In-deep interview IUD Intrauterine Device RH Reproductive Health STI Sexual Transmission Infection UNFPA United Nations Fund for Population Activities WHO World Health Organization 7 TIEU LUAN MOI download : skknchat@gmail.com Chapter 1 : Introduction 1.1 Problem Statement Ho Chi Minh city is the biggest city in Vietnam with the estimated total of residents at about 7.2 million including of 2.3 million of males and 2.4 million of females which are in the age from 15 to 65 (Statistical Office in HCMC, 2010). Along with the development of urbanization, industrialization and globalization, social and cultural life has many changes in recent years.
However, as the traditional notions in Vietnam and other Asian countries, sexual content is taboo for talking in public. Meanwhile, as said above, the impressive growth of economy also brings the huge change of society, including the sexual health issues. In which, the main sexual and reproductive health issues are sexual transmitted infection, unplanned pregnancy and unsafe abortion (Low, 2006). Proportion of women in reproductive age suffer STIs is 25%, proportion of abortion and menstrual regulation is 0.
HIV / AIDS in Vietnam is really an alarming problem. 156,802 people living with HIV were reported, including 34,391 AIDS patients alive and 44,232 people died because of AIDS. So far, HCMC is the highest cases of people who are living with HIV accounted for 26.3% of HIV cases detected in the country (Ministry of Health, 2010). HIV transmission is primarily through heterosexual sex and injecting drug use.
However, the biggest challenge facing Vietnam in the field of RH is the issue of abortion. The use of contraceptive method is reflected in low rate while the abortion rate continues to rise in Vietnam. The average women abortion rate is 2. This number was the highest in Southeast Asia and was one of the highest rates in the world.
Strikingly, while education program and media communication system have attempted to raise awareness of people, they do not really change their behaviour apparently. Many young women lacked basic knowledge about sex, including not believing in using condoms or not asking their partner to use condoms. Furthermore, a negative view on abortion has caused 8 TIEU LUAN MOI download : skknchat@gmail.com many women choose the unsafe and illegal abortions. In Vietnam, mortality rate from unsafe abortions is one per week.
In Vietnam, sex education in school already gives the basic knowledge, such as biology, gender and personal development, hygiene, and family life. However, the teaching methods used are often not suitable for sensitive topic like this (WHO, 1999). School is main source to provide knowledge about sexual health, but this information is poor and unelaborated. Teachers still avoid mentioning about this topic in their lectures (Nguyen et., 1999), which brings the lack of sufficient and efficient information and causes the curiosity to the adolescent about sexual health.
So, it could lead to the shortage in sexual health protection, insufficient knowledge about transmission diseases, unplanned pregnancy and abortion. As the economy of HCMC has been growing rapidly, rising in income and income inequality has probably changed many of people’s behaviour, including sexual health protection behaviour. However, the relationship between protection behaviour and income, which has important policy implication, has not been fully understood. The income has positive correlation with education factor (Pereira and Martins, 2004), but not with sex health protection behaviour.
This study also tries to figure out what the difference between income groups in intended behaviour towards sexual health protection.2 Research Objectives From this problem statement, this research examines the sexual health protection behavior of urban HCMC participants using qualitative method. First of all, this research try to find out the attitudes and perception (A&P) towards sexual health protection, subjective norm about sexual health protection and perceived behavioral control of sexual health protection behavior. Besides, this research also tries to exam the relationship between A&P and sexual health protection behavior, between subjective norms and sexual health protection behavior, between perceived behavioral control and sexual health protection behavior. Moreover, this research tries to figure out these connections by income groups, including low-income and high-income groups.
9 TIEU LUAN MOI download : skknchat@gmail.com 1) What is the attitudes and perception, subjective norms, perceived behavioral control towards sexual health care/protection? 2) What is the connection between attitudes and perception, subjective norms, perceived behavioural control to sexual health protection behaviour? 3) What are the differences in these connections among income group? 1.3 Research Scope This research was carried out in HCM city. The sample size was 21 participants, including 8 male and 14 female, aged from 18-40 years old.4 Research Structure The based theory of this study is presented at chapter 2; then, followed by empirical study. Chapter 3 reviewed research backgrounds and research methodology, in which study presented about analytical framework, qualitative method: explain why we should use qualitative method for this research, tool to do the research: we use NeedScope model during the interview, and interpretation about the participants of this study. Chapter 4 point out some results of the study, then chapter 5 gave some conclusion and policy recommendation.
10 TIEU LUAN MOI download : skknchat@gmail.com Chapter 2 : Literature reviews 2.1 Theory of Planned Behavior Icek Ajzen introduced the theory of planned behaviour via his article “From intentions to actions: a theory of planned behaviour” in 1985. Including 3 main categories in this theory, this theory is a development from the theory of reasoned action, which first proposed by Martin Fishbein and Icek Ajzen in 1975. These three main categories are: Attitudes and Perception – it shows the information if a person prefers to take action or not, Subjective Norms – shows the social pressure limitation that a person could stand to take action and Perceived Behavioral Control–shows the perception of a person about the ease or difficulty to performing a behavior. According to this theory, a person’s behavior intention is high accuracy predicted by his or her attitudes towards action, their belief of what other thinks they would act and their thought of what they can do this behavior.
From the behavior intention determinants, it importantly accounts for performing actual behavior. Attitudes and Perception refers to the favorable or unfavorable evaluation or the appraisal of a person about a phenomenon or a behavior. It first begins with the perception towards this phenomenon or behavior. From this, leading to the belief that the outcome will happen from performing the behavior is good or bad.
If the attitude towards this action is good, he or she will have the positive belief of intending to perform the behavior. Then, it will lead to the positive outcome of performing the behavior. And vice versa, if the attitude towards this action is bad, he or she will have the negative outcome of intending to undertake the behavior, lead to less likely to perform the actual behavior. This factor answers for question “Whether the person is in favor of doing it?” Subjective Norms refers to own estimation of a person about the social pressure to perform or not perform an action.
The social pressure here is the people that this individual perceived that important to him or her. This factor has two parts: belief about how people would like them to perform action (e. I feel pressure from my parents to use condom in my sexual relationship); and the positive or negative judgment about the consequences of 11 TIEU LUAN MOI download : skknchat@gmail.com the belief (e. doing what my parents think I should do is important).
Based on how much this person values the social pressure, the degree of the influences will fluctuate. This factor answers the question “How much the person feels social pressure to do it?” Perceived Behavioral Control refers to a person’s perception of factors will facilitate or hinder an intention to behave. These could be an internal control factors (such as: knowledge, skill or ability), or external control factors (such as: opportunities, or resources). These factors could be actual or not, as long as it exists in his or her belief.
The importance is how strong the individual think he or she can control these factors. This shows the ease or difficulty in intending of doing or not doing the behavior. This factor answers the question “Whether the person feels in control of the action in question?” In these three factors, The Perceived Behavioural Control is the most important factor (Ajzen, 1985). For example, a male would like to have a safe sex by using condom, as he has known that he might infect STI/HIV by not using condom.
This is Attitude towards the behaviour of buying condom. And he has also heard about protecting himself by using condom from his friend because they always use it and he intends to use it too. This presents of Subjective Norm. However, the pharmacy where sale condom is far, and he think that it will be embarrassed if he come to ask for condom or suffer the curious looks from the people there.
Moreover, he may get some unexpected question from pharmacist. In fact, there is no curios question or sneer at all. Nevertheless, this fact plays a very important role for his decision that he will not go to buy condom, even he is totally aware of this use of this behaviour and also get encourage from others to behave. Attitudes and Perception, Subjective Norms and Perceived Behavioural Control all affect to intention to act, as well as each other.
And it should be noted that three above factors only determine the intention to act, not the actual behaviour; then, the intention to act is the strongest indicator that may or may not lead to the behavioral action (Ajzen, 1985). This theory has been shown to be useful when collecting information for future development of public health program (Nutbeam and Harris, 1997, Ajzen, 2002).