REPLACE2: Community-based intervention development and pilot evaluation addressing FGM in Europe

Abstract

Background: An estimated 500 000 women in Europe have been subject to Female Genital Mutilation (FGM). Every year, 180 000 more women and girls are at risk. Health consequences can be severe, even fatal. Interventions to address FGM focus on awareness-raising, lack a theoretical basis, and are seldom evaluated. This research aimed to update, trial and evaluate the REPLACE cyclic framework for addressing FGM drawing on systematic behaviour change intervention development frameworks at individual and community levels. Methods: The updated REPLACE cyclic framework was applied to community-based intervention development in five European FGM affected communities. Mixed methods were applied in evaluation including pre-post questionnaires and focus groups. Data were collected from 96 intervention participants (total project reach exceeded 500). t-tests were applied to questionnaire data and thematic analysis to qualitative data. Findings: Targets for change and therefore findings varied by intervention and community, with evidence of a positive change in some target beliefs (e.g. significant increase in the belief ‘FGM is not required by Islam’ by Dutch Somalis [t(df=21)=-2.852, p=.01)]. Focus group data reflected strengthened beliefs, and showed evidence that community members were better able to talk in-depth and with confidence about ending FGM in their communities. Discussion: This is the first attempt to provide and evaluate a systematic approach to developing and evaluating participatory, community-focussed interventions drawing on theory and evidence from behaviour change addressing FGM. Findings are promising for making progress to end this harmful traditional practice. REPLACE adopters’ feedback will support development and improvement of the framework.