Qualitative analysis of sexual health protection behavior by income the case of ho chi minh city

INSTITUTE OF SOCIAL STUDIES
THE HAGUE
THE NETHERLANDS

UNIVERSITY OF ECONOMICS
HO CHI MINH CITY
VIETNAM

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

J

Table of Contents
Chapter 1 :

Introduction ...................................................................................................... 8

1.1

Problem Statement ................................................................................................... 8

1.2

Research Objectives ................................................................................................. 9

1.3

Research Scope ...................................................................................................... 10

1.4

Research Structure ................................................................................................. 10

Chapter 2 :

Literature reviews ........................................................................................... 11

2.1

Theory of Planned Behavior .................................................................................. 11

2.2

Empirical Studies ................................................................................................... 13

2.3

Chapter Summary .................................................................................................. 16

Chapter 3 :

Research backgrounds and research methodology ......................................... 17

3.1

Research backgrounds ......................................................................... ~ ................. 17

3.2

Research Methodology .......................................................................................... 19

3.2.1

Analytical framework ................................................................. 19

3.2.2

Qualitative methods .................................................................. 21

3.2.3

Tool. .................................................................................... 25

3.2.4

Participants and studied location ................................................... .29

3.3

Chapter Summary .................................................................................................. 32

Chapter 4 :
4.1

Empirical results ............................................................................................. 33

Description of variables ......................................................................................... 33

4.1.1

Attitude and perception ............................................................... 33

4.1.2

Subjective Norms ..................................................................... 39

4.1.3

Perceived Behavior Control. ....................................................... .41

4.2

Determinants of sexual health protection behavior ............................................... 45

4.2.1

Attitude/perception and sexual health protection behavior ..................... .45

4.2.2

Subjective Norms and sexual health protection behavior ....................... .47

4.2.3

Perceived behavior control and sexual health protection behavior ............ .48

4.3

Chapter Summary .................................................................................................. 49

3


Chapter 5: Conclusions and policy implication .................................................................... 50
5.1

Conclusions ............................................................................................................ 50

5.2

Policy Implication .................................................................................................. 51

5.3

Limitation ............................................................................................................... 52

REFERENCES ..................................................................................................................... 53

Appendix A .......................................................................................................................... 56
Appendix B ........................................................................................................................... 59
Appendix C ........................................................................................................................... 61
Appendix D .......................................................................................................................... 63

;

4


Table of Figures
Figure 1: Theory of Planned Behaviour .................................................................................... 20
Figure 2: The layer of needs ...................................................................................................... 26
Figure 3: The collages ofNeedScope model .............................................................................. 28

5


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


...

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


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, 201 0).
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 0.8% (UNFPA, 2009).
HIV I 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% ofHIV 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 2.5 times. 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


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 gtves 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.
al., 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.

1.2

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


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.

1.4

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


Chapter 2 : Literature reviews
2.1

Theory ofPlanned Behavior

leek 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 leek 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?"
Su~jective

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.g. I feel pressure from my parents to use condom in
my sexual relationship); and the positive or negative judgment about the consequences of

11


the belief (e.g. 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 ofthe 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

ofthis 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

i~tention

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). Taking an

12


example, if Ministry of Education and Training and Ministry of Health want to build a
sexual education program for adolescent; they have to understand of teenagers' perceptions
of HIV/STis and their action would be taken by themselves for sexual health protection.
And it is crucial to understand the social pressures as well as the influence around
adolescent about sexual health protection. Understanding all information, the program
could be built and implemented more practically and efficiently.

2.2

Empirical Studies

Sexual health protection is researched at many countries and many time periods. Overall,
the research problem is to understand the thinking about sex (including opinions, thoughts,

as well as the availability to the sex of participants, or sex before marriage), learn about the
participant's knowledge of sexual relations on health protection (themselves and partners)
before the disease spread through sexual contact and HIV I AIDS and unwanted
pregnancies; find understand the sources of information that participants know about sex,
or sexual health. These studies are performed on samples of adolescents and women.
Wanapa Naravage and Joachim Oehler have a research of "Sexual Risk Perception
among Women at Reproductive Age, Bangkok, Thailand" (2008), using qualitative and

quantitative method. Firstly, this study was using quantitative research to identify the
variables; then the qualitative research will be taken to explain the identified variables, and
in-depth understand risk perception towards STis/HIV and unplanned pregnancy. This
study was carried out for both married and single female from 15 to 45 years old at
workplaces, shopping malls at downtown and outskirt of Bangkok, Thailand. Data
collection was conducted in November 2005 to January, 2006. This research found plenty
of significant information: sexual risk perception More Than Half of Women Perceived No
Risk At All From HIV Infection, Unplanne9 Pregnancy Was Seen More Common Than
HIV/AIDS Reported by Respondents, Majority of Respondents Are Less Concerned about
HIV Infection Than About Unplanned Pregnancy, Most Participants Who Were Single Feel
Less Concerned about HIV Infection Due to Lack of Early Symptoms, Unlike Pregnancy,

13


as well as, it discussed some about preventing sexual risk, like using condom or oral
contraceptive pill ... This result was useful in Thailand.
Research ofNguyen Thi Hoai Due, Anke Van Dam, Vu Thu Ha, Phan Thanh Tuyen
about "Knowledge, Attitude, Behaviour of adolescent related to sexual and
reproductive health in Hanoi and Ninhbinh", was carried out in 1999. The method is
used is focus discussion group, with adolescent from 15-19 years old. The key finding
showed that the source to provide information about sexual health is from school, but they

are poor and unelaborated. The teachers still avoided mentioning about the sexual topic in
lectures. The most contraception method was condom. The adolescent supposed the sexual
education from school and family ... This research was not up-to-date, and its sample4 size
was in adolescent.
"The Love barrier - The view of young Vietnamese woman regarding their
intentions to remain virgins until marriage" research of Ida Neuman (2006) investigated
about how young, urban Vietnamese women's perceive their sexual and reproductive health
situation and have sex before marriage. It was also a qualitative method research which
based on focus group discussion with young woman, her mother and her boyfriend to
analyse their perception about remaining virgins until marriage. This study was conducted
from October to December, 2004 in Hanoi, Vietnam, interviewed 12 daughters and 11
mothers (daughters are from 19-24 years old, not married, and lived at home with their
mother). Based on Theory of Planned Behaviour and using phenomenography method, this
research gave the perception of young women in remaining virgins until marriage.
The result of this study showed that there were some barriers in perception of women
in the research towards sexual and productive health. There was a conflict between their
desires to discovery and live for their love to their family perception and pressure. The
result also divided in terms of Attitudes and Perception, Subjective Norms and Perceived
Behavioural Control, which given in summary and implications. This result showed in
some important view of daughter about keeping virgin before marriage; they understood the
negative consequences of having sexual intercourse with their boyfriend before marriage

14


could cause reducing his respect to them after that, the STis, the social pressures or
negative impact if getting married with other guy. However, they still lacked of control in
the situation could lead to sexual intercourse with their boyfriend somehow. Moreover, the
sexual talk between mom and daughter rarely happens; then, the information about sexual
issue mostly has gotten from media channel, not from family (mother in this case). This

research also pointed out some limitations, such as: the result only occur between women,
no man's views about premarital sex. It also shows the cultural and language barrier when
carried out this research.
In the study "Knowledge of sexual and reproductive health among adolescents
attending school in Kelantan, Malaysia" (20 11 ), authors assessed the understanding of
participants via a self-administered, anonymous questionnaire of quantitative method.
Exclusive of demography, this study mentioned about knowledge of human reproductive
organs, pregnancy, contraception, HIV and STDs, abortions and their sources of sexual and
reproductive health information. At the similar culture to Vietnam, Malaysia was also
facing the hesitance in talking about sexual issues between family members. Most sources
of sexual and reproductive health information came from friends (64.3%) and mass media
(60.2%); not from parents (6.5%) or teachers (17.2%). Insisting the WHO statement (2005)
that knowledge levels among school age towards sexual and reproductive health vary by
location, age and sex, the study also gave some findings about the misunderstanding of
adolescent, such as: not having pregnancy at "first time". More importantly, majority of
students did not know that sexual intercourse is a cause of STDs, but knowing about HIV.
The study pointed out the lack of education at school and family or community about
sexual knowledge.
Another study also mentioned about the perceptions of contraception, named
"Perceptions of couples about contraception in Eastern India" (Mundie et. at., 2011).
The samples of this study were married women from urban and rural at West Bengal, India.
The method was quantitative research, with 2000 respondents, via a predesigned
questionnaire. Interviewing method was also used, but with only the female partner
randomly. In this study, the variables were age, age at marriage, age at first conception,

15


parity, birth interval, occupation, literacy level, socioeconomic condition, knowledge about
contraceptive, current use of contraception and ever use of contraception. The result

distinguished to the age of females (younger than 18, 18-23, 24-29, 30-35 and from 36
upper), region (Hindu, Muslim, others). Only 5% of respondents had main role in family
planning decision maker; most came from both sides (husband and wife) in home (55.2%).
Most important finding at this study was that literacy is essential determinants of
knowledge towards family planning methods.

2.3

Chapter Summary

In all above empirical studies, some of them are executed in Vietnam long time ago, so the
result is not appropriate for current circumstance. Some of them are implemented with the
sample of adolescent. Some of them used quantitative method with pre-designed
questionnaire, which unable to show the in-deep understanding of participants. So, based
on Theory of Planned Behavior, our study carried out to know the Attitude and Perception,
Subjective Norms and Perceived Behavioral Control towards the sexual health protection
behaviour. Using advantages of qualitative method, we try to know the in-deep
understanding of participants with this kind of sensitive topic. Next chapter presented why
this study chose qualitative method, and also explain about the NeedScope model we use
during interview with participants. Details of participants are also given at next chapter.

16


Chapter 3 : Research backgrounds and research
methodology
3.1

Research backgrounds

Vietnam's transition from an underdeveloped economy to a middle-income country has
coincided with the rapid urbanization process. The latest census data in 2009 showed that
Vietnam's urban population over 25 million, accounting for 29.6% of the total population,
an increase of 40.4% compared to the previous census results in 1999. Ho Chi Minh City
and other cities in Vietnam are growing along with the process of urbanization. According
to the economists, the city exists for enterprises and employees will be more productive
activities in close proximity. This is called the advantage gained from the gathering in the
same place (Duranton and Puga, 2004). When businesses close together, they can support
each other in many aspects of production, labor, distribution, services or consumer. And
HCMC is typical in gathering production and residential activities. Economic growth of
HCMC is 11% or even faster 50%, while the average economic growth of Vietnam is
nearly 7% in the past 10 years. Vietnam's urban population nominal rate is 3.6% per year,
from 1999 to 2005, but the actual rate is properly 5%, if counting for migrants and the
urban extension. Meanwhile, the official population of the city in 2007 was 6.6 million, an
increase of 3.1% annually since 2002. Nevertheless, the entire population including migrant
workers can be up to 8. 7 million people. Independent estimates also showed an absolute
increase of 400 to 500 thousand people per year in the city (Dapice et. al., 201 0).
Until 2010, HCMC population is 7.2 million, while age from 15 to 65 is 4.7 million,
male has 2.3 million, and female has 2.4 million (Statistical Office in HCMC, 2010). Along
with the huge development of economic, cultural, social life of people also increase a big
step. The penetration of many outside culture around the world also brings a lot different
thinking to the urban. Reported from survey in 2010 outlined in the online conference with
ministries, departments, representing 63 Department of Information and Communication
across the country on 11th Oct that besides the percentage of households with home

17


telephone, personal computer, statistics also show that the rate in HCM City households
have Internet connection is 33%, the percentage of households using Internet is 35%.This

helps to open opportunities to reach to the world cultures.
However, the consequences also accompany with this development. The Ministry of
Public Health in Vietnam has reported that there are about 300,000 people in Vietnam has
infected with HIV since this disease was discovered about 30 years ago. Currently, HCMC
has the highest rate of people has HIV which is at 560 infected over 100,000 people. The
proportion of HIVI AIDS infected of male: female was 4:1, and the majority of women got
HIVI AIDS infection from their partners (Ministry of Health, 201 0). By analysing the cases
of HIV in HCMC, what happened in the first 5 months of 2012 similar to 2011: working
age 20-39 still account for a large portion of infection cases 82.9%. The transmission
occurred mostly via drug injection and sexual intercourse (male-male and male-female).
Entire 24 districts and 322 communes and townships have case of HIV infection.
Moreover, prevalence of women has continued to increase: 28.3% in 2011, and 31.4% in
the first five months of 2012 (HIVIAIDS Control and Prevention Committee of HCMC,
2012).
Beside the risk of the sexual transmission disease, women in Vietnam are facing with
unplanned pregnancies, and abortion. These are big challenges to women, especially for
young women who had unsafe sex as it will be huge changes in their lives. The problem of
unwanted pregnancy and unsafe abortion among adolescents and young people is a problem
in Vietnam is very interested, especially Ho Chi Minh City. According to the General
Office for Population Family Planning of Vietnam in 2011, Vietnam has the highest in
Southeast Asia and the fifth in the world of abortion in adolescents (aged 15-19 years).
Every year, there are average about 300,000 cases of abortion at the age of 15-19,
accounting for 22% of all abortions. And there is more serious when it is in an uptrend.
Particularly in HCMC, the number of abortions is three times more than (66 cases/100 live
births), the number of abortions has about 4% in adolescents and young adults. The concern
is abortion ranked third among the causes of death for pregnant women and one of the
causes of infertility.

18

3.2

Research Methodology

This study used only qualitative method to explore the understanding of participants
towards sexual health protection (or some time called sexual risk prevention). Qualitative
methods have much to offer those studying health care and health services (Pope and May,
2006). With this kind of sensitive topic, the qualitative method is used as the flexible way
to discover the in-deep understanding of people. The respondents of this research were the
21 women and men, with a range from 18 to 40 years old. HCMC with the rapid
development and population explosion as we mention above was chosen as the place for
this research. We had the face to face discussion in the in-deep interview (IDI). The
discussion took place during Jun and July, 2011. The respondents were chosen in HCMC,
should be sufficient with some kinds of condition, called screening, as above description;
and selected with different level of income.
This study used only qualitative method, using NeedScope method. Firstly, we used
the designed questionnaire to look for the relevant respondents. The respondents of this
research could be the urban woman and men, with a range age from 18 to 40 years old. This
phase endured until we find out enough respondents to take in to in-deep interview. We
face-to-face discussed about perception of sexual health protect.

3.2.1 Analytical framework
The research use Theory of Planned Behavior as the foundation theory to finds the result
about sexual health protection. The questions for the interview also followed the basic of
theory, and the framework of this research is as below.

19

Figure 1: Theory of Planned Behaviour

Attitudes and
Perception

Subjective Norms

Behavioral
Intention

Behavior

Perceived
Behavioral Control

A&P shows the information whether a person prefers to take action or not. In this
study, discussion found out the understanding or belief of the respondents about the sexual
risk prevention. If the participants believe that the behavior as undertaking sexual risk
prevention bring the positive outcome, he or she will likely have more positive attitude
towards doing this prevention. And vice versa, if he or she believes that this prevention
does not bring any good outcome, they will less likely to intend to do this action. Sexual
risk prevention mention at this study was HIV/STis disease, unplanned pregnancy. The
questions used to reveal the understanding were:
What comes to your mind when saying about "sex"?
What do you think about sex relationship?
What do you know about sexual risk and sexual risk prevention?
Subjective Norms shows the beliefs about the normative expectations of others to
their intentional behavior. In this study, subjective norms showed the information about
what important people of participants think about of sexual risk prevention. The more

20


participants value their important people's social approval, the stronger the influences of
them could take into account with participants. Therefore, the motivation could affect the
participants' intentional behavior. The significant people here could be their parents, close
friends, siblings, or their partner ... To explore the result of subjective norms, the questions
were used:
Who you could share or ask if you have concern about sex
relationship/sexual risk prevention?
Most people who are important to you think that you should use sexual risk
prevention method when having sex?
How much their sharing do you want to be like them?

Perceived Behavioral Control shows the beliefs about the presence of factors that
may facilitate or difficulty the performance of the behavior. According to theory, the
person's intention to behavior will be much greater if they could handle the factors that
may affect to their action. In this study, we need to discover which kind of factor could
have facilitate or impede the action of participants is using the risk prevention method, and
how much this factor could lead to the determinant of using risk prevention methods. To
discover this, the question was used:
What advantage/ disadvantage of using sexual risk prevention method

3.2.2 Qualitative methods
With the sensitive social theme, qualitative research, along with NeedScope method,
promises more practical result potentially. Qualitative method is also appreciated for health
research itself. Qualitative methods have much to offer those studying health care and
health services (Pope and May, 2006). Comparing to quantitative method is for seeking to
confirm hypotheses about phenomena, to quantity variation; qualitative method is for
seeking to explore phenomena, to describe variation, describe and explain relationship, to

describe individual experiences, to describe group norms (Mack et. a!., 2005). Using the
open-end question format, qualitative method has the flexibility in some aspects of study

21


the response of participants affect the how and which questions researchers· ask next.
Moreover, the study design of qualitative method is iterative, data collection and research
questions are adjusted according to what is learned. With the most important difference to
quantitative research is flexibility, qualitative method brings the most comfortable
atmosphere to the discussion and gives the spontaneous and pure response from
participants. Besides, these open-end questions give respondents the opportunity to
responds by their own words, which could apart from what researcher expect, and give
useful, rich and explanatory answers in nature.
There are three most common qualitative methods. Participant observation, which is
for collecting data appropriately, based on observe what behavior participant act in their
usual circumstance, naturally. In-depth interview is used in this study, which is for
collecting data on individual's experience, personally, one-to-one, face-to-face talk; this
method is normally used in case of being explored sensitive. The private atmosphere will
give the pleasant and comfort for respondents. Focus group discussion is for collecting the
data on the cultural norms of group and creating the general view of points of one concern
in the cultural groups.
Taking the advantage of qualitative research, and NeedScope model, the in-deep
interview started after participants were screened. First of the discussion, we share some
general information about participant; share the opinion about the sex, sexual relationship,
then about sexual risk and sexual risk prevention. Because this respondent was screened to
make sure that he/she feel open-heart to share sensitive information. This conversion leads
to their sexual life and which kind of prevention method they use currently or before. At
this step, we based on which kind of method they use to ask for next question. This could
be condom, oral contraception pill, cervical cap, or behavioral method. It depended on

participant choice, and then we lead the next question. Besides, the discussion talked about
the person who participant believes in sharing sensitive information with. Following
respondents information, we asked to know how strong this person could affect the
participant's intentional behavior. Besides, the discussion revealed the factors that affect to
their behavior. For example, the respondent talked about using condom will make him feel

22


itchy; we follow his sharing to ask about which advantage or disadvantage of using
condom, and more. That information may be just the spontaneous action that they're not
aware of act, but they could give many benefits in the result. Then, we asked them for using
the NeedScope model. In this phase, showing them the show card with six groups,
represent for men or women nowadays, and asked them to match with some kind of
prevention method that they list above; then, guided participant to talk about this archetype.
The questions are the same with what they were asked above, but repeat for six groups.
When talking about other person, not himself, the participant would be very free to talk
about this. Through which, it shows the most nature perception, opinion in them, especially
at archetype who has the same choice of method with them. Through this method, we could
have the purest information from participants which we wish to have at this study.
As the Theory of Planned Behavior above, in the in-deep interview, we try to figure
out the attitudes and perceptions, subjective norm and perceived behavior control.
Difference to quantitative method, at qualitative method, we elicit the sharing of
participants via the open question, then rely on the answer, we ask the next question. As
above description, we have some specific questions for each part of sections to elicit the
information. During the interview, we did not try to keep the order of the questions that
have to follow the flow of attitudes, subjective norm and then perceived behavior control.
Instead, we based on the sharing of the respondents, and then try to elicit the needed
information. Certainly, the question has to follow the flow of guide line question. The detail
of the question guide is in appendix. Here, I would like to highlight the key and the purpose

of questions in the in-deep interview.
First of all, we mention about the definition of the attitudes and perception,
subjective norm and perceived behavior control. In the Theory of Planned Behavior, it
already describes the key idea of three above elements. To go to the purpose of predicting if
an individual intends to do something, we need to know:
Whether the person is in favor of doing it: it comes to know the "Attitude"

23


How much the person feels social pressure to do it: it comes know the
"Subjective Norm"
Whether the person feels in control of the action in question: it comes to
know the "Perceived Behavioral Control"
In this study, we need to know what the A&P about sexual risk prevention is. First
of all, the interviewer has to know what is the sexual risk and sexual risk prevention. Sexual
risks are mentioned at this research is the STis, HIV/AIDS and unplanned pregnancy.
Sexual risk prevention methods are mentioned was the method used before, during or after
the intercourse. In this research scope, they could be condom, daily oral contraception pill,
emergency contraception pill, IUD and behavioral method.
To elicit the participant' responses about this, the interview begins with the question
about their sexual lives, then linked to their sharing about sexual risk and sexual risk
prevention method they used to use or use currently. The question is:

What do you think ofsexual risk/ sexual risk prevention?
What kind of sexual risk prevention you know?
About the subjective norms towards using sexual risk preventions, the study
mentioned about the think of the most people who are important to respondent towards
using prevention method. Most people here could be parents, close friends, friends,
relatives or sexual spouse. To find out who is important and how strong they affects to

respondents' intention to behave, that start from this kind of questions:

From which one/source did you come to know this prevention method?
How do you parents said if they know you use/not use this prevention
method?
How does your spouse feel/feedback if you use/not use this prevention
method?

24


About the perceived behavior control towards sexual risk preventions, this research
referred about the ease or difficulty towards using/not using the prevention methods. They
could be the side effects of oral contraception pill, or could be the unpleasant feeling when
using this method. The questions are:
What are the main reasons for using/ not using this method?
Why do you use this method?

If the side effects like this, how to you feel when using this method?
What are the concerns about this prevention method you wish you could
avoid or find a solution to?
What would you look for in using this method?

During the interview, we played a very important role for the spontaneous answers,
it revealed the highest priority of participant to the question. For example, if the question is
"why did you use the condom?" the answered .is "I do not want to get pregnant before
marriage" spontaneously. That means the most important thing in their mind is
"pregnancy", not "STis".

3.2.3 Tool

This research was using the NeedScope method during the discussion to creating the
comfortable and trusted environment. NeedScope™ is a qualitative and quantitative
research system for understanding and managing emotion throughout the marketing
process, which is used by research market organization around the world. This method is
described as below.

NeedScope Model
Originally, The NeedScope model which is a state of the art model, aims to unravel the
relationships between consumer needs and brand images. NeedScope is a qualitative and
quantitative research system for understanding people's emotion. It uses the archetypes
model, which classified based on two sets of archetypes: Affiliation (warm and receptive)

25


vs. Individualism (assertive and independent) and Dynamic vs. Static (outward vs.
inward).For every layer of consumers' needs, there is a corresponding layer of brand image
which associate with one services or product. In our paper, this is a tool to understand indeep interviewee when talking about sensitive issue.
Technically, NeedScope has three elements form foundation; which make the
system uniquely able to measure and understand emotion. This is Consumer-Brand
relationship model, Psychological model, and Projective tool.

Figure 2: The layer of needs

Source: The NeedScope System™

Consumer-Brand relationship model:

Consumer needs are complex and multi-layered, including Functional needs,
Identity needs, and Emotional needs. Functional needs surface clearly and we're

easy to catch up. For example, with the cell phone brand, everyone acknowledges
the original function of cell phone is for immediate and direct communication,
including talk/hear and send/receive message. However, the Emotional needs lurk
beyond the functional and identity needs. That causes why this person likes Nokia

26