Please use this identifier to cite or link to this item: https://doi.org/10.1186/s12992-018-0358-5
Title: Using qualitative and community-based engagement approaches to gain access and to develop a culturally appropriate STI prevention intervention for foreign female entertainment workers in Singapore
Authors: Lim, R.B.T. 
Cheung, O.N.Y.
Tham, D.K.T. 
La, H.H. 
Win, T.T.
Chan, R. 
Wong, M.L. 
Keywords: census
disease control
human immunodeficiency virus
population size
prostitution
qualitative analysis
sexually transmitted disease
womens employment
Article
community care
condom use
cost
cultural factor
disease transmission
female
female entertainment worker
health care access
health care availability
human
Human immunodeficiency virus infection
infection prevention
infection risk
interview
language
named groups by occupation
population size
priority journal
qualitative analysis
sexually transmitted disease
Singapore
stigma
clinical trial
condom
cultural competence
ethnology
health care delivery
health promotion
migrant
participatory research
procedures
program evaluation
psychology
qualitative research
sex worker
sexually transmitted disease
statistics and numerical data
Thailand
Viet Nam
Singapore [Southeast Asia]
Human immunodeficiency virus
Community-Based Participatory Research
Condoms
Cultural Competency
Emigrants and Immigrants
Female
Health Promotion
Health Services Accessibility
Humans
Program Evaluation
Qualitative Research
Sex Workers
Sexually Transmitted Diseases
Singapore
Thailand
Vietnam
Issue Date: 2018
Publisher: BioMed Central Ltd.
Citation: Lim, R.B.T., Cheung, O.N.Y., Tham, D.K.T., La, H.H., Win, T.T., Chan, R., Wong, M.L. (2018). Using qualitative and community-based engagement approaches to gain access and to develop a culturally appropriate STI prevention intervention for foreign female entertainment workers in Singapore. Globalization and Health 14 (1) : 36. ScholarBank@NUS Repository. https://doi.org/10.1186/s12992-018-0358-5
Abstract: Background: There is an increasing global movement of foreign female entertainment workers (FEWs), a hard-to-reach population vulnerable to HIV/STIs. This paper described the needs assessment phase before intervention implementation where the socio-organisation, sexual risk behaviours and access to health services of foreign FEWs in Singapore were explored. We also highlighted how qualitative inquiry, census enumeration technique and community-based engagement approaches were used to gain access and to develop a culturally appropriate STI prevention intervention. Methods: In-depth interviews, observations, informal conversational interviews, mystery client and critical incident technique were used. We estimated the size of FEW population using the census enumeration technique. The findings were used to inform intervention development and implementation. Results: We estimated 376 Vietnamese and 330 Thai FEWs in 2 geographical sites where they operated in Singapore. Their reasons for non-condom use included misconceptions on the transmission and consequences of STI/HIV, low risk perception of contracting HIV/STI from paid/casual partner, lack of skills to negotiate or to persuade partner to use condom, unavailability of condoms in entertainment establishments and fear of the police using condom as circumstantial evidence. They faced difficulties in accessing health services due to fear of identity exposure, stigmatisation, cost and language differences. To develop the intervention, we involved FEWs and peer educators, and ensured that the intervention was non-stigmatising and met their needs. To foster their participation, we used culturally-responsive recruitment strategies, and ensured that the trial was anonymous and acceptable to the FEWs. These strategies were effective as we achieved a participation rate of 90.3%, a follow-up rate of 70.5% for the comparison and 66.8% for the intervention group. The interventions group reported a significant increase in consistent condom use with a reduction in STI incidence compared to no significant change in the comparison group. Conclusions: The qualitative inquiry approaches to gain access, to foster participation and to develop a culturally appropriate intervention, along with the census enumeration technique application to estimate the FEW population sizes has led to successful intervention implementation as well as safer sexual behaviour and STI incidence reduction. © 2018 The Author(s).
Source Title: Globalization and Health
URI: https://scholarbank.nus.edu.sg/handle/10635/174543
ISSN: 17448603
DOI: 10.1186/s12992-018-0358-5
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