Female genital mutilation/cutting (FGM/C) is widely considered a human rights infringement, although communities that practice the tradition view it as an integral part of their culture. Given these vastly different views, the effectiveness of efforts to abandon FGM/C is uncertain. We conducted a systematic review of the best available evidence regarding evaluations of interventions to prevent FGM/C, including eight controlled before‐and‐after studies with 7,042 participants from Africa. Findings indicate that 19 of 49 outcomes (with baseline similarity) were significantly different at study level, mostly favoring the intervention, but results from four meta‐analyses showed considerable heterogeneity. The limited effectiveness and weak overall quality of the evidence from the studies appear related to methodological limitations of the studies and shortcomings in the implementation of the interventions. Nevertheless, the findings point to possible advantageous developments from the interventions.
Interessen for å samle og syntetisere kvalitative studier i systematiske oversikter er voksende. Det pekes blant annet på at sammenstillinger av kvalitativ forskning har stor verdi når det gjelder potensialet til å informere politikk og praksis. Systematiske oversikter om effekt gir innsikt i hvorvidt et tiltak virker; systematiske oversikter med kvalitativ forskning gir innsikt i hvordan og hvorfor eventuelle virkninger oppstår. Nytten av denne type oversikter erkjennes nå bl.a. av internasjonale organisasjoner som Cochrane og Campbell-samarbeidene. I Cochrane-håndboka vises det til at kvalitativ forskning kan bidra med nyttig informasjon på flere måter: Kvalitative datasett kan informere, styrke, utvide og supplere systematiske oversikter om effekt av tiltak. Metodene for gjennomføring av oversikter med kvalitativ forskning er i rask utvikling, og det fins for øyeblikket ingen standard tilnærming. Når det gjelder søk etter kvalitative studier må disse ofte være bredere, men forøvrig gjelder mange av de samme prinsippene som for litteratursøk innen systematiske oversikter om effekt av tiltak. Det forskes på og debatteres om hva slags kriterier som bør benyttes i utvelgelsen av kvalitative studier og hvorvidt man skal ekskludere studier basert på metodologisk kvalitet. Det fins flere ulike måter å syntetisere resultater fra kvalitative studier på, og det er også mulig å sammenstille resultater fra både kvalitative og kvantitative studier i én analyse. De mest hyppig brukte metodene er metaetnografi og tematisk analyse.Berg RC, Munthe-Kaas H. Systematic reviews in qualitative research. Nor J Epidemiol 2013; 23 (2): 131-139.ENGLISH SUMMARYThere is growing interest in summarising and synthesising qualitative research in systematic reviews. Among other things, this indicates an increasing appreciation for the potential role of qualitative evidence in informing policy and practice. While systematic reviews of effect studies can establish whether an intervention works, systematic reviews of qualitative research can offer insights into the "how" and "why" of potential effects. The importance of such questions, and the value of systematic reviews of qualitative research, is now recognized by a number of international organizations, including the Cochrane and Campbell Collaborations. The Cochrane Handbook describes four ways in which qualitative research can contribute to evidence-based practice, namely by informing, enhancing, extending, and supplementing systematic reviews of the effect of interventions. The methodology for conducting reviews of qualitative research is rapidly developing, and at present there is no standard approach. Systematic searches for qualitative research are often more broadly cast but otherwise follow many of the same principles of a literature search within a systematic review of effect. There are ongoing debates and research regarding criteria for inclusion of studies in general, and whether to include studies of low methodological quality in particular. An array of methods to synthesise qualitative evidence exists, and such evidence may also be synthesised together with quantitative evidence. Meta-ethnography and thematic analysis are the most commonly used synthesis methods.
AbstractIn a sample of men who have sex with men (MSM) (N = 3436) in Spain who bear intrinsic HIV risk, we investigated how internalised homonegativity (IH) is associated with the number of non-steady male partners with condomless intercourse (as a proxy of sexual risk behaviour). Using structural equation modelling (SEM), we examined the relationship between IH and sexual risk behaviour, and mediating effects of HIV/PrEP knowledge and substance use during sex on this relationship. We found no direct association between IH and sexual risk behaviour, nor did IH influence substance use during sex. In line with our hypothesis, association between IH and sexual risk behaviour was significant when mediated by HIV/PrEP knowledge. We found that as IH increased, sexual risk behaviour decreased, because higher IH was associated with lower HIV/PrEP knowledge while higher HIV/PrEP knowledge was associated with increased non-condom use with non-steady partners. Substance use during sex was significantly associated with sexual risk behaviour. Our results emphasize the continuing importance of prevention strategies focused on behavioural changes and community level interventions, especially targeting substance use.
In a sample of men who have sex with men (MSM) (N=3436) in Spain who bear intrinsic HIV risk, we investigated how internalised homonegativity (IH) is associated with the number of non-steady male partners with condomless intercourse (as a proxy of sexual risk behaviour). Using structural equation modelling (SEM), we examined the relationship between IH and sexual risk behaviour, and mediating efects of HIV/PrEP knowledge and substance use during sex on this relationship. We found no direct association between IH and sexual risk behaviour, nor did IH infuence substance use during sex. In line with our hypothesis, association between IH and sexual risk behaviour was signifcant when mediated by HIV/PrEP knowledge. We found that as IH increased, sexual risk behaviour decreased, because higher IH was associated with lower HIV/PrEP knowledge while higher HIV/PrEP knowledge was associated with increased non-condom use with non-steady partners. Substance use during sex was signifcantly associated with sexual risk behaviour. Our results emphasize the continuing importance of prevention strategies focused on behavioural changes and community level interventions, especially targeting substance use. ; Open Access funding provided thanks to the CRUE-CSIC agreement with Springer Nature. EMIS-2017 was carried out as part of ESTICOM, under the service contract 2015 71 01 with The Consumers, Health, Agriculture and Food Executive Agency (Chafea), acting under powers delegated by the Commission of the European Union. The contract arises from the Call for tender No Chafea/2015/Health/38.
