Table 1 Information on the questionnaires reviewed
Authors | Country | Items evaluated | Number of Participants | Caregivers categories | Tool employed | Availability of the tool | Development of the tool | Interests | Gaps |
|---|---|---|---|---|---|---|---|---|---|
1)Moeed 2012 | Australia | Experience | 530 | Fellows, diplomats and trainees provided by Royal Australian and New Zealand College of Obstetricians and Gynecologists | Questionnaire: 7 questions | Yes | - | Evaluation of experience of reinfibulation | Basic assessment of previous encounters with women with FGM and theoretical knowledge. No evaluation of clinical knowledge and management of FGM, prevention and law |
2)Sureshkumar 2016 | Australia | Knowledge, attitude, experience, awareness of clinical guidelines, education/training needs | 497 | Pediatricians | Questionnaire: 31 questions | Yes | Working group of expert clinicians (general pediatrics, child protection, obstetrics and gynecology) and the founder of African Women Australia. Questionnaire piloted for acceptability, content and clarity by ten pediatricians from different specialties and amended according to feedback | Evaluation of awareness/knowledge of guidelines | Basic evaluation of previous experience, awareness and theoretical knowledge on FGM. No evaluation of clinical knowledge and management of FGM, prevention and law |
3)Leye 2008 | Belgium | Knowledge, attitude and practice | 334 | Gynecologists | Questionnaire: 26 questions | Yes | Based on a similar survey conducted in Switzerland among midwives, gynecologists, pediatricians and social services | Evaluation of awareness/knowledge of guidelines. Evaluation of knowledge and attitude on reinfibulation, cosmetic surgery, piercing and pricking. Assessment of experience of medicalization | Basic evaluation of previous experience, awareness and theoretical knowledge on FGM. No evaluation of clinical knowledge and management of FGM, prevention |
4)Cappon 2015 | Belgium | Knowledge, attitude and practice | 820 | Midwives | Questionnaire: 23 questions | Yes | Adapted from a survey conducted among Flemish gynecologists. Pilot study among midwives who were not part of the study population. Their feedback was integrated in the final version of the questionnaire | Evaluation of awareness/knowledge of guidelines. Evaluation of knowledge and attitude on reinfibulation, cosmetic surgery, piercing and pricking. Assessment of experience of medicalization | Basic evaluation of previous experience, awareness and theoretical knowledge on FGM. No evaluation of clinical knowledge and management of FGM, prevention |
5)Kaplan 2009 | Spain | Knowledge, attitude and practice | 225 in 2001 and 184 in 2004 | Family physicians, pediatricians, nurses, midwives and gynecologists | Questionnaire: 9 questions | Yes | - | - | Basic assessment of previous encounters with women with FGM and theoretical knowledge. No evaluation of clinical knowledge and management of FGM, prevention and law |
6)Tamaddon 2006 | Sweden | Knowledge, experience | 769 | Midwives, gynecologists, pediatricians. Hospital, youth clinics, maternal health clinics, school physicians and nurses | Questionnaire: 10 questions | Yes | Informally preview of the questionnaire by a few midwives and gynecologists, a pediatrician, and a school nurse, and then improved before it was sent out to the survey group | - | Basic evaluation of previous experience with patients with FGM. No objective assessment of knowledge, attitude and practice |
7)UNICEF 2012 | Switzerland | Knowledge and practice. Knowledge of guidelines | 1053 | Obstetricians, gynecologists, midwives and asylum personnel | Questionnaire: 21 questions | Yes | Same survey in 2001, 2004 | Assessment of availability of certified interpreters | Basic assessment of previous encounters with women with FGM and theoretical knowledge. No evaluation of clinical knowledge and management of FGM, prevention and law |
8) UNICEF 2016 | Switzerland | Knowledge and practice | 75 | Obstetricians, gynecologists, midwives and asylum personnel | Questionnaire: 33 questions | Yes | - | Assessment of awareness of asylum rights based on FGM | Basic assessment of previous encounters with women with FGM and theoretical knowledge. No evaluation of clinical knowledge and management of FGM, prevention and law |
9)Elliott 2016 | UK | Knowledge and attitude | 49 | Psychosexual therapists | Questionnaire: 21 questions | Yes | Developed from an earlier and briefer version | Evaluation of knowledge and attitude on reinfibulation, cosmetic surgery among men and women, piercing and pricking, male circumcision, parents legal responsibility | Basic assessment of theoretical knowledge. No evaluation of clinical knowledge and management of FGM, prevention and law |
10)Relph 2013 | UK | Knowledge, attitude and training | 79 | Obstetricians, pediatricians, midwives, student midwives, foundation year trainees and medical students | Questionnaire: 19 questions | Yes | Based on the Royal College of Obstetrics and Gynecology guidelines and on similar questionnaires by authors from Belgium and Egypt. Small pilot study on 5 participants (medical students, junior doctors and a consultant in obstetrics and gynecology) | Evaluation of attitude includes medicalization, age of consent, reinfibulation, cosmetic surgery and genital piercing, male circumcision | Basic assessment of clinical and theoretical knowledge on FGM, defibulation, law. No evaluation of clinical knowledge and management of FGM, prevention and law |
11)Purchase 2013 | UK | Knowledge of guidelines | 607 | Fellows and trainees of the Royal College of Obstetricians and Gynecologists | Questionnaire: 19 questions | Yes | On-line survey based on the Royal College of Obstetrics and Gynecology guidelines | Knowledge score. Questions on communication | Basic assessment of clinical and theoretical knowledge on FGM, defibulation, law, referral. No evaluation of clinical knowledge and management of FGM, prevention and law |
12)Jacoby 2013 | U.S. | Confidence in management of FGM type III | 11 | Midwives | Questionnaire: 9 questions | Yes | Evaluation of a training course with 9 objectives, The participants were asked to rate these objectives using a 5-point Likert scale ranging from no confidence to very confident | Evaluation of confidence in counseling women before defibulation, recording FGM | Basic assessment of confidence in management of women with FGM type III. No evaluation of clinical knowledge and management of FGM, prevention and law |
13)Hess 2010 | U.S. | Knowledge and experience | 243 | Midwives and nurses members of the American College of Nurse-Midwives | Questionnaire: 13 questions | Yes | Review by 3 nurses who had experience in women’s health and with clients with a history of FGM. No pilot study before distribution of the survey | Evaluation of knowledge about cultural beliefs on FGM and stigmatization of migrant circumcised women. Assessment of cesarean section indication because of FGM | Basic assessment of theoretical knowledge on FGM and law. No evaluation of clinical knowledge and management of FGM, prevention and law |
14)Kaplan 2013 | Gambia | Knowledge, attitude and practice | 468 | Nurses and midwives | Questionnaire: 36 questions | Yes | Pilot study conducted in 2 regions of the country among 97 caregivers. Designed by a medical anthropologist researcher with a thorough and extensive ethnographic background in The Gambia, following the implementation of barrier analysis using focus group discussions among Gambian men and women of all ethnic groups | Evaluation of alternative initiation rites to FGM. Information on daughter’s circumcision, existence of FGM in the own family, opinions on how to stop FGM | Basic assessment of theoretical knowledge on FGM and law. No evaluation of clinical knowledge and management of FGM, prevention and law |
15)Kaplan 2016 | Gambia | Knowledge, attitude and practice | 1288 | Nurses, midwives, public health officers, students of medicine, nursing, midwifery, and public health degrees | Questionnaire: 36 questions | Yes | Pilot study conducted in 2 regions of the country | Evaluation of alternative initiation rites to FGM. Information on daughter’s circumcision, existence of FGM in the own family, opinions on how to stop FGM | Basic assessment of theoretical knowledge on FGM and law. No evaluation of clinical knowledge and management of FGM, prevention and law |
16)Onuh 2006 | Nigeria | Knowledge, attitude, practice | 182 | Nurses | Questionnaire: 20 questions | Yes | Information collected included ethnic group, religion, being circumcised, daughter’s circumcision, medicalization and traditional myths | Basic assessment of clinical and theoretical knowledge on FGM. No evaluation of clinical knowledge and management of FGM, prevention and law | |
18)UNFPA 2016 | Sudan | Knowledge, attitude and perception | 308 | Midwives | Questionnaire: 29 questions | Yes | - | - | Basic assessment of previous encounters with women with FGM and theoretical knowledge. No evaluation of clinical knowledge and management of FGM, prevention and law |
19)Widmark 2002 | Sweden | Knowledge, attitude, practice, emotions, communication | 26 | Midwives | Questionnaire (associated to interviews and focus groups) | No | A Kenyan sociologist, a Swedish midwife and a Somali physician | - | - |
20)Zaidi 2007 | UK | Knowledge, experience and practice | 45 | Midwives, Obstetricians | Questionnaire | No | 2 senior clinicians, based on recommendations of the Royal College of Obstetrics and Gynecology | - | - |
21) Refaat 2009 | Egypt | Determinants of medicalization of FGM | 193 | Physicians | Questionnaire: 72 questions | No | Based on a conceptual model hypothesized by the author whereby physicians may be practicing FGM due to: cultural influences, financial benefits, or lack of knowledge about the consequences | - | - |
22)Refaat 2007 | Egypt | Knowledge and attitude | 50 | Recently graduated physicians | Questionnaire | No | - | - | - |
23)Rasheed 2011 | Egypt | Attitude | 801 | Nurses, young and senior pediatricians and gynecologists | Questionnaire | No | - | - | - |
24)Mostafa 2006 | Egypt | Knowledge, attitude, beliefs | 330 | Medical students (5th year) | Questionnaire | No | Based on literature review. Revision by 3 community medicine professors | - | - |
Egypt | Knowledge and beliefs | 1070 | University students | Questionnaire: 32 questions | No | - | Evaluation of information sources | - | |
27)Newman 2003 | Mali | Knowledge, skills and awareness | 120 | Reproductive health providers | Questionnaire | No | Developed to assess a national FGM curriculum | - | - |
28)Adekanle 2011 | Nigeria | Knowledge and experience | 250 | Physicians, nurses, midwives | Questionnaire | No | Based on the government passage of bill against FGM | - | - |
29)Ashimi 2014 | Nigeria | Knowledge and attitude | 350 | Nurses | Questionnaire | No | Pre-tested | - | - |
30)Ali 2012 | Sudan | Knowledge and attitude | 157 | Midwives and TBA | Questionnaire | No | - | - | - |