A hybrid, effectiveness-implementation research study protocol targeting antenatal care providers to provide female genital mutilation prevention and care services in Guinea, Kenya and Somalia

Abstract

Background In settings with high prevalence of female genital mutilation (FGM), the health sector could play a bigger role in its prevention and care of women and girls who have undergone this harmful practice. However, ministries of health lack clear policies, strategic plans or dedicated funding to implement anti-FGM interventions. Along with limited relevant knowledge and skills to prevent the practice of FGM and care for girls and women living with FGM, health providers have limited interpersonal communication skills and self-efficacy, while some may have supportive attitudes towards FGM and its medicalization. We propose to test the effectiveness of a health system strengthening intervention that includes training antenatal care (ANC) providers on person-centred communication (PCC) for FGM prevention. Methods This will be a two-level, hybrid, effectiveness-implementation research study using a cluster randomized trial design in Guinea, Kenya and Somalia conducted over a 6 months period. In each country, within pre-selected regions/counties, 60 ANC clinics will be randomized to intervention and control arms. At baseline, all clinics will receive the level one intervention involving provision of FGM-related clinical guidelines and handbook as well as anti-FGM policies and posters. At month 3, intervention clinics will receive the level two intervention comprising of a training for ANC providers on PCC to challenge their FGM-related attitudes and build their communication skills to effectively provide FGM prevention counselling. A process evaluation will be conducted to understand ‘how’ and ‘why’ the intervention package achieves intended results. Multi-level regression modelling will be used for quantitative data analysis while qualitative data will be assessed using thematic content analysis to determine the effectiveness, feasibility and acceptability of the different intervention levels. Discussion The proposed study will strengthen the knowledge base regarding how to effectively involve health providers in FGM prevention and care. Trial registration Trial registration and date: PACTR201906696419769 (June 3rd, 2019).

Involving the health sector in the prevention and care of female genital mutilation: results from formative research in Guinea

“…In this regard, formative research was carried out by the Centre for Research on Reproductive Health in Guinea— Cellule de recherche en santé de la reproduction en Guinée (CERREGUI) with the support of WHO and HRP during the months of April and May 2018, to inform the development of an intervention targeting health care providers to strengthen their role in FGM prevention and care by gaining a better understanding of the contextual situation regarding FGM and its medicalization in Guinea. The intervention package is being field tested in a multi-country implementation research study in Kenya, Guinea, and Somalia [ 8 ]. The specific objective of this paper is to discuss the factors that emerged from this formative research that facilitate or impede the health sector in its role in strengthening FGM prevention and care efforts.…”

Female genital mutilation and cutting in the Arab League and diaspora: A systematic review of preventive interventions

“…Designs included six quasi-experimental studies [37,[39][40][41][42]44], four descriptive qualitative [38,43,45,46], one participatory action research [47] and one randomised controlled trial with no data to report because of delays due to COVID-19 [36].…”

“…Three further studies conducted in Sudan [38,39,42] and one study in the United Kingdom [43] used different forms of media designed to change FGM/C attitudes. An ongoing study protocol by Ahmed and colleagues [36] intends to use personalised communication, leaflets, posters and clinical tools to increase knowledge and assist health professionals implementing sessions aiming at reducing FGM/C. Sample sizes for the studies ranged from whole communities with no fixed reported number to small samples of 13.…”

“…Eight studies [36][37][38][39][40][41][42] described interventions reporting on preventive interventions within Arab League States. Four studies [43] described interventions in the Arab diaspora (Table 2).…”

“…Ten interventions focussed on education with the aim of improving knowledge and changing beliefs and attitudes towards FGM/C [37][38][39][40][41][42][43][44][45][46]; one on improving the knowledge of medical professionals and strengthening healthcare systems [36]. Only one study employed a multi-sectoral approach over a 6-year period in five European Union Countries with eight immigrant communities, three of which originated from Arab League member states [47].…”