Article type
Year
Abstract
Background: Realist synthesis is an emerging approach to systematically reviewing research evidence on complex social interventions, which provides an explanatory analysis of how and why they are (or not) effective in particular contexts or settings. While there is considerable interest in conducting realist syntheses there are few exemplars of how to do this.
Objectives: We present results of and methodological perspectives on a realist synthesis of FGM/C abandonment efforts.
Methods: The Cochrane Handbook guidance on including qualitative evidence in reviews of effects was used to inform the development of a realist synthesis approach and conduct of our review. Exhaustive searches sought two types of studies: 1)controlled studies to examine the effectiveness of FGM/C abandonment programs; 2) studies using qualitative and other methods to describe the factors related to the continuance and discontinuance of FGM/C ('views' studies). We combined quantitative data with data from views studies and the results of the synthesis were described in a model explaining how efficacy (outcome patterns) of an intervention varied depending on the particular configuration of its constituent mechanisms and contexts.
Results: The searches yielded 7517 records. For the effectiveness synthesis, we included eight controlled before-and-after studies of low methodological quality (7042 participants). There were four types of interventions, covering seven intervention areas in Africa. Few studied the field’s reality before rolling out the intervention. Four meta-analyses showed limited effectiveness and considerable heterogeneity affected the interpretation. For the views synthesis, we located 26 studies, covering all but one intervention area. The synthesis of these studies was used to illuminate the effectiveness findings. In general, sexual morals and religion were poorly addressed and the degree to which the interventions were appropriate responses to the populations' situation regarding FGM/C varied.
Conclusions: Realist synthesis is a valuable but time-consuming approach requiring advanced reviewer skills in several assessment and analysis areas.
Objectives: We present results of and methodological perspectives on a realist synthesis of FGM/C abandonment efforts.
Methods: The Cochrane Handbook guidance on including qualitative evidence in reviews of effects was used to inform the development of a realist synthesis approach and conduct of our review. Exhaustive searches sought two types of studies: 1)controlled studies to examine the effectiveness of FGM/C abandonment programs; 2) studies using qualitative and other methods to describe the factors related to the continuance and discontinuance of FGM/C ('views' studies). We combined quantitative data with data from views studies and the results of the synthesis were described in a model explaining how efficacy (outcome patterns) of an intervention varied depending on the particular configuration of its constituent mechanisms and contexts.
Results: The searches yielded 7517 records. For the effectiveness synthesis, we included eight controlled before-and-after studies of low methodological quality (7042 participants). There were four types of interventions, covering seven intervention areas in Africa. Few studied the field’s reality before rolling out the intervention. Four meta-analyses showed limited effectiveness and considerable heterogeneity affected the interpretation. For the views synthesis, we located 26 studies, covering all but one intervention area. The synthesis of these studies was used to illuminate the effectiveness findings. In general, sexual morals and religion were poorly addressed and the degree to which the interventions were appropriate responses to the populations' situation regarding FGM/C varied.
Conclusions: Realist synthesis is a valuable but time-consuming approach requiring advanced reviewer skills in several assessment and analysis areas.