An Assessment of an Educational Intervention Program Based on the Health Belief Model for Safer Sex Among Female Sex Workers in Selected Districts of Northern Region of Malawi

Abstract Background: Pregnant women are at risk of pregnancy if they have unprotected sex, do not use or poorly use contraceptives in the context of penile-vaginal sex. We therefore developed an educational toolkit based on the Health Belief Model (HBM) to assist FSWs to make informed sexual and reproductive decision for safer sex before and/or after heterosexual encounter with their clients. We evaluated the educational intervention programme among FSWs and other stakeholders (nurses and clinicians).Methods:This was a qualitative operational research. We developed an educational tool kit based on the HBM to aid FSWs to make informed decision for safer sex behaviour. We conducted 10 in-depth interviews (IDIs) to identify the components of the educational tool kit, 5 IDIs for modification and refining the tool, and consequently two Focus Group Discussions (FGDs) for consensus building. This process was done in Mzimba North. After the intervention we conducted 6 FGDs with FSWs and 10 IDIs with nurses and clinicians to evaluate the applicability and feasibility of the intervention among female sex workers (FSWs) in Mzimba North, and Nkhata Bay located in Northern region of Malawi.Results:We observed mixed opinions on the components of the educational toolkit. Female sex workers were eager to understand misinformation and misconceptions on contraceptives, right to justice, effectiveness of contraceptives. Female sex workers requested the inclusion of STIs and HIV prevention and economic empowerment in the toolkit. Overall the toolkit and the educational intervention were relevant, feasible, and applicable among the study participants. Conclusion:While several strategies can be used to facilitate the implementation of the evidence based intervention to improve health, our educational intervention program based on the Health Belief Model for safer sex behaviour among female sex workers was found to be feasible and applicable in our study settings. We believe that the intervention may be helpful to address sexual and reproductive health challenges encountered by FSWs in the study sites and elsewhere.