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Crossing cultural divides: a qualitative systematic review of factors influencing the provision of healthcare related to female genital mutilation from the perspective of health professionals

Evans, C.; Twehheyo, R.; McGarry, J.; Eldridge, J.; Albert, J.; Nkoyo, V.; Higginbottom, G.

Authors

Dr CATRIN EVANS CATRIN.EVANS@NOTTINGHAM.AC.UK
Professor of Evidence Based Healthcare

R. Twehheyo

J. McGarry

J. Eldridge

J. Albert

V. Nkoyo

G. Higginbottom



Abstract

Introduction
As a result of global migration, health professionals in destination countries are increasingly being called upon to provide care for women and girls who have experienced female genital mutilation/cutting (FGM/C). There is considerable evidence to suggest that their care experiences are sub-optimal. This systematic review sought to illuminate possible reasons for this by exploring the views, experiences, barriers and facilitators to providing FGM-related healthcare in high income countries, from health professionals’ perspectives.

Methods
Sixteen electronic databases/resources were searched from inception to December 2017, supplemented by reference list searching and suggestions from experts. Inclusion criteria were: qualitative studies (including grey literature) of any design, any cadre of health worker, from OECD countries, of any date and any language. Two reviewers undertook screening, selection, quality appraisal and data extraction using tools from the Joanna Briggs Institute (JBI). Synthesis involved an inductive thematic approach to identify descriptive themes and interpret these into higher order analytical constructs. Confidence in the review findings was assessed using GRADE-CERQual. The review protocol was registered with PROSPERO (CRD420150300042015).

Results
Thirty papers (representing 28 distinct studies) from nine different countries were included. The majority of studies focused on maternity contexts. No studies specifically examined health professionals’ role in FGM/C prevention/safeguarding. There were 20 descriptive themes summarised into six analytical themes that highlighted factors perceived to influence care: knowledge and training, communication, cultural (mis)understandings, identification of FGM/C, clinical management practices and service configuration. Together, these inter-linked themes illuminate the ways in which confidence, communication and competence at provider level and the existence and enactment of pathways, protocols and specialist support at service/system level facilitate or hinder care.

Conclusions
FGM/C is a complex and culturally shaped phenomenon. In order to work effectively across cultural divides, there is a need for provider training, clear guidelines, care pathways and specialist FGM/C centres to support mainstream services.

Citation

Evans, C., Twehheyo, R., McGarry, J., Eldridge, J., Albert, J., Nkoyo, V., & Higginbottom, G. (2019). Crossing cultural divides: a qualitative systematic review of factors influencing the provision of healthcare related to female genital mutilation from the perspective of health professionals. PLoS ONE, 14(3), https://doi.org/10.1371/journal.pone.0211829

Journal Article Type Article
Acceptance Date Feb 20, 2019
Online Publication Date Mar 4, 2019
Publication Date Mar 4, 2019
Deposit Date Mar 4, 2019
Publicly Available Date Mar 4, 2019
Journal PLoS ONE
Electronic ISSN 1932-6203
Publisher Public Library of Science
Peer Reviewed Peer Reviewed
Volume 14
Issue 3
Article Number e0211829
DOI https://doi.org/10.1371/journal.pone.0211829
Keywords General Biochemistry, Genetics and Molecular Biology; General Agricultural and Biological Sciences; General Medicine
Public URL https://nottingham-repository.worktribe.com/output/1604903
Publisher URL https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0211829#sec005