Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
BMJ Open. 2021 Mar 22;11(3):e039809. doi: 10.1136/bmjopen-2020-039809.
Little is known about the management of female genital mutilation (FGM) in primary care. There have been significant recent statutory changes relevant to general practitioners (GPs) in England, including a mandatory reporting duty. We undertook a realist synthesis to explore what influences how and when GPs discuss FGM with their patients.
Primary care in England.
Realist literature synthesis searching 10 databases with terms: GPs, primary care, obstetrics, gynaecology, midwifery and FGM (UK and worldwide). Citation chasing was used, and relevant grey literature was included, including searching FGM advocacy organisation websites for relevant data. Other potentially relevant literature fields were searched for evidence to inform programme theory development. We included all study designs and papers that presented evidence about factors potentially relevant to considering how, why and in what circumstances GPs feel able to discuss FGM with their patients.
This realist review developed programme theory, tested against existing evidence, on what influences GPs actions and reactions to FGM in primary care consultations and where, when and why these influences are activated.
124 documents were included in the synthesis. Our analysis found that GPs need knowledge and training to help them support their patients with FGM, including who may be affected, what needs they may have and how to talk sensitively about FGM. Access to specialist services and guidance may help them with this role. Reporting requirements may complicate these conversations.
There is a pressing need to develop (and evaluate) training to help GPs meet FGM-affected communities' health needs and to promote the accessibility of primary care. Education and resources should be developed in partnership with community members. The impact of the mandatory reporting requirement and the Enhanced Dataset on healthcare interactions in primary care warrants evaluation.
CRD42018091996.
对于初级保健中女性外阴残割（FGM）的管理知之甚少。近年来，英格兰的全科医生（GP）发生了重大的法规变化，包括强制性报告职责。我们进行了一项实际的综合研究，以探讨哪些因素影响 GP 与患者讨论 FGM 的方式和时间。
英格兰的初级保健。
使用术语对 10 个数据库进行真实的文献综合搜索：GP、初级保健、产科、妇科、助产士和 FGM（英国和全球）。使用引文追踪，并包括相关的灰色文献，包括搜索 FGM 倡导组织网站以获取相关数据。还搜索了其他潜在相关文献领域，以获取有助于制定方案理论的证据。我们纳入了所有研究设计和论文，这些论文提供了与考虑 GP 在初级保健咨询中如何、为何以及在何种情况下能够与患者讨论 FGM 相关的潜在因素的证据。
这项真实的综述针对 GP 在初级保健咨询中对 FGM 的行为和反应的影响因素以及这些影响因素的激活地点、时间和原因，开发了针对现有证据进行测试的方案理论。
综合分析纳入了 124 份文件。我们的分析发现，GP 需要知识和培训来帮助他们支持有 FGM 的患者，包括可能受影响的人、他们可能有哪些需求以及如何敏感地谈论 FGM。获得专业服务和指导可能会帮助他们发挥这一作用。报告要求可能会使这些对话复杂化。
迫切需要开发（和评估）培训，以帮助 GP 满足受 FGM 影响的社区的健康需求，并促进初级保健的可及性。教育和资源应与社区成员合作开发。强制性报告要求和增强数据集对初级保健中医疗保健互动的影响值得评估。
CRD42018091996。
