Are There "Stages Of Changes" in The Practice Of Female Genital Cutting?: Qualitative Research Findings from Senegal and The Gambia.
), Yiva Herniund(2),
(1)
(2)
Corresponding Author
Abstract
In recent years there has been growing interest in developing theoretical models for understanding behaviour change with respect to the practice of female genital cutting (FGC). Drawing on extensive qualitative data collected in Senegal and The Gambia, the research reported here explores whether and how theoretical models of stages of behaviour change can be applied to FGC. Our findings suggest that individual readiness to change the practice of FGC is most clearly seen as operating along a continuum, and that broad stages of change characterise regions or segments of this continuum. Stages identified by previous researchers for other "problems behaviours" such as smoking inadequately describe readiness to change FGC since this decision is often a collective rather than individual one. The data reveal that the concept of stage of change is a complex construct that simultaneously captures behaviour, motivation, and features of the environment in which the decision is being made. Consequently stages identified in this research reflect the multidimensional nature of readiness to change the practice of FGC. Limitations of stage of change models as applied to FGC include the fact that they do not capture important aspects of the dynamics of negotiation between decision-makers, and do not reflect the shifting nature of opinions of individuals or the constellation of decision-makers. Nonetheless, we suggest the application of stage of change theory may provide a useful means of describing readiness for change of individual decisions-makers and at an aggregate level, patterns of readiness for change in a community. How this construct can be employed in quantitative population research requires further investigation. (Rev Afr Santé Reprod 2006; 10[2]:57-71)
Keywords: Female genital cutting, Trans-theoretical model, stage of change, decision-making, Senegal, The Gambia.
References
Population Reference Bureau. Abandoning Female Genital Cutting: Prevalence, Attitudes, and Efforts to End the Practice. (Population Reference Bureau, Washington, D.C., 2001).
WHO. Female Genital Mutilation: Programmes to Date: What Works and What Doesn't. A Review. (World Health Organization, Geneva, 1999).
Frontiers in Reproductive Health/Population-Council. Using Operations Research to Strengthen Programmes for Encouraging Abandonment of Female Genital Cutting. (Report of a Consultative Meeting on Methodological Issues for FGC Research April 9-11, 2002, Nairobi, Kenya, 2002).
Carey, K. B., Purnine, D. M., Maiso, S. M. & Carey, M. P. Assessing readiness to change substance abuse: A critical review of instruments. Clinical Psychology: Science and Practice 6, 245-266 (1999).
Janz, N. K. & Becker, M. H. The health belief model: A decade later. Health Education Quarterly 11, 1-47 (1984).
Ajzen, I. & Madden, T. J. Prediction of goal-directed behavior: Attitudes, intentions, and perceived behavioral control. Journal of Experimental Social Psychology 22, 453-474 (1986).
Fishbein, M. & Ajzen, I. Belief, Attitude, Intention and Behavior: An Introduction to Theory and Research (Addison-Wesley, Reading, MA, 1975).
Izette, S. & Toubia, N. Learning about Social Change. A Research and Evaluation Guidebook Using Female Genital Cutting as a Case Study (RAINBO, New York, 1999).
Rogers, E. Diffusion of Innovation (The Free Press, New York, 1995).
Prochaska, J. O. & DiClemente, C. C. Transtheore-tical therapy: Toward a more integrative model of change. Psychotherapy Theory, Research and Practice 19, 276-288 (1982).
Prochaska, J. O. & DiClemente, C. C. In search of how people change: Applications to addictive behaviors. American Psychologist 47, 1102-1114 (1992).
Prochaska, J. O., Norcross, J. C. & DiClemente, C. C. Changing for Good (Morrow, New York, 1994).
Brown-Peterside, P., Redding, C. A., Ren, L. & Koblin, B. A. Acceptability of a stage-matched expert system intervention to increase condom use among women at high risk of HIV infection in New York City. AIDS Education and Prevention 12, 171-181 (2000).
Quinlan, K. B. & McCaul, K. D. Matched and mismatched interventions with young adult smokers: Testing a stage theory. Health Psychology 19, 165-171 (2000).
Prochaska, J. O., et. al. Stage of change and decisional balance for 12 problem behaviors. Health Psychology 13, 39-46 (1994).
Diop, N. J., et. al. The Tostan Program: Evaluation of a Community Based Education Program in Senegal. (2003).
Toubia, N. F. & Sharief, E. H. Female genital mutilation: Have we made progress yet? Interna-tional Journal of Gynaecology and Obstetrics 82, 251-261 (2003).
Parker, W. Rethinking conceptual approaches to behavior change: The importance of context. (Centre for AIDS Development, Research and Evaluation (CADRE), 2004).
Davies, P. & SIGMA, P. On relapse: Recidivism or rational response? In AIDS: Rights, Risk and Reason (eds. Aggelton, P., Davies, P. & Hart, G.) 133-141 (The Falmer Press, Washington D.C., 1992).
Ingham, R., Woodcock, A. & Stenner, K. The limitations of rational decision-making models as applied to young people's sexual behaviour. In AIDS: Rights, Risk and Reason (eds. Aggleton, P., Davies, P. & Hart, G.) 163-173 (The Falmer Press, Washington, D.C., 1992).
Melkote, S. R., Muppidi, S. R. & Goswami, D. Social and economic factors in an integrated behavioural and societal approach to communi-cation in HIV/AIDS. Journal of Health Communication 5, 17-27 (2000).
Yoder, P. S. Negotiating relevance: Belief, knowledge, and practice in international health projects. Medical Anthropology Quarterly 11, 131-146 (1997).
Yoder, P. S. From sexual behavior to sexual encounters: Issues in AIDS prevention research. Reviews in Anthropology 30, 225-
(2001).
Shell-Duncan, B. Conceptual and Methodological Issues in Studying Sociocultural Determinants of Female Genital Cutting.
Paper presented at the Conference: Advancing Research on Female Genital Cutting (Bellagio, Italy, May 2002.).
Sylla, M. H. S. Excision au Sénégal. (ENDA, Dakar, 1990).
Daffeh, J., Dumbuya, S. & Sosseh-Gaye, A. Listening to the Voice of the People: A Situation Analysis of Female Genital Mutilation in The Gambia. (WHO, UNFPA, UNICEF, 1999).
Hernlund, Y. Winnowing Culture: Negotiating Female "Circumcision" in The Gambia. Doctoral Dissertation (University of Washington, Seattle, 2003).
Hernlund, Y. Cutting without ritual and ritual without cutting: Female "circumcision" and the re-ritualization of initiation in the Gambia. In Female "Circumcision" in Africa: Culture, Controversy, and Change (eds. Shell-Duncan, B. & Hernlund, Y.) 235-252 (Lynne Rienner Publishers, Boulder, CO, 2000).
Shell-Duncan, B. & Hernlund, Y. Female genital cutting in Senegambia: Setting the stage for change. Paper presented at the Annual Meeting of the American Anthropological Association (November 30-December 4, Chicago, IL, 2005).
Weinstein, N. D., Rothman, A. J. & Sutton, S. R. Stage theories and health behavior: Conceptual and methodological issues. Health Psychology 17, 290-299 (1998).
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