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      Female Genital Mutilation/Cutting Education for Midwives and Nurses as Informed by Women’s Experiences: Protocol for an Exploratory Sequential Mixed Methods Study

      research-article
      , BNurs, BMid, BHlthSc (Hons) 1 , 2 , , , BHsc, PGCRM, PGDipHE, MCGI, PhD 1 , , BMid, BNurs, MMid, MBA, PhD 1 , , BAppSc (Dev Dis), Grad cert (Rehab), BMid (Hons), PhD 1 , , BNurs, GradDipMgt, MNurs 3
      JMIR Research Protocols
      JMIR Publications
      education, midwives, nurses, female genital mutilation/cutting, maternity care, women’s health care, knowledge, attitude, practice

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          Abstract

          Background

          Female genital mutilation/cutting (FGM/C) is a complex and deeply rooted sociocultural custom that is innately entrenched in the lives of those who continue its practice despite the physical and psychological dangers it perpetrates. FGM/C is considered a significant independent risk factor for adverse maternal and fetal outcomes in pregnancy and childbirth. Several studies in high-income countries have explored the experiences and needs of women with FGM/C as well as the knowledge of the health professionals, particularly midwives and nurses, who care for them. However, to date, no studies have evaluated the implementation of education for health professionals in high-income countries to meet the specific needs of women with FGM/C.

          Objective

          This study aims to explore the impact of an FGM/C education program for midwives and nurses as informed by the experiences of women with FGM/C accessing maternity, gynecological, and sexual health services in South Australia.

          Methods

          This study will adopt a three-phase, exploratory sequential mixed methods design. Phase 1 will involve the exploration of women with FGM/C views and experiences accessing maternity and gynecological (including sexual health) services in South Australia. The findings from phase 1 will inform phase 2: the development of an educational program for midwives and nurses on the health and cultural needs of women with FGM/C. Phase 3 will involve the evaluation of the program by measuring midwives’ and nurses’ changes in knowledge, attitude, and practice immediately before and after the education as well as 4 months after completing the program. Phase 1 of this study has been approved by the Women’s and Children’s Health Network human research ethics committee (ID number 2021/HRE00156) and the University of South Australia human research ethics committee (ID number 204096).

          Results

          Phase 1 will commence in August 2021, with the interpretation of findings being undertaken by November 2021. Phase 2 will be developed and facilitated by February 2022, and the final phase of this study will begin in March 2022. This study is expected to be completed by February 2023.

          Conclusions

          The findings of this research will provide insight into the development and evaluation of education programs for midwives and nurses that includes collaboration with women from culturally and linguistically diverse backgrounds to address the specific cultural and health needs of communities.

          International Registered Report Identifier (IRRID)

          PRR1-10.2196/32911

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          Most cited references52

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          Achieving integration in mixed methods designs-principles and practices.

          Mixed methods research offers powerful tools for investigating complex processes and systems in health and health care. This article describes integration principles and practices at three levels in mixed methods research and provides illustrative examples. Integration at the study design level occurs through three basic mixed method designs-exploratory sequential, explanatory sequential, and convergent-and through four advanced frameworks-multistage, intervention, case study, and participatory. Integration at the methods level occurs through four approaches. In connecting, one database links to the other through sampling. With building, one database informs the data collection approach of the other. When merging, the two databases are brought together for analysis. With embedding, data collection and analysis link at multiple points. Integration at the interpretation and reporting level occurs through narrative, data transformation, and joint display. The fit of integration describes the extent the qualitative and quantitative findings cohere. Understanding these principles and practices of integration can help health services researchers leverage the strengths of mixed methods. © Health Research and Educational Trust.
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            Code Saturation Versus Meaning Saturation: How Many Interviews Are Enough?

            Saturation is a core guiding principle to determine sample sizes in qualitative research, yet little methodological research exists on parameters that influence saturation. Our study compared two approaches to assessing saturation: code saturation and meaning saturation. We examined sample sizes needed to reach saturation in each approach, what saturation meant, and how to assess saturation. Examining 25 in-depth interviews, we found that code saturation was reached at nine interviews, whereby the range of thematic issues was identified. However, 16 to 24 interviews were needed to reach meaning saturation where we developed a richly textured understanding of issues. Thus, code saturation may indicate when researchers have "heard it all," but meaning saturation is needed to "understand it all." We used our results to develop parameters that influence saturation, which may be used to estimate sample sizes for qualitative research proposals or to document in publications the grounds on which saturation was achieved.
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              Are We There Yet? Data Saturation in Qualitative Research

              Failure to reach data saturation has an impact on the quality of the research conducted and hampers content validity. The aim of a study should include what determines when data saturation is achieved, for a small study will reach saturation more rapidly than a larger study. Data saturation is reached when there is enough information to replicate the study when the ability to obtain additional new information has been attained, and when further coding is no longer feasible. The following article critiques two qualitative studies for data saturation: Wolcott (2004) and Landau and Drori (2008). Failure to reach data saturation has a negative impact on the validity on one’s research. The intended audience is novice student researchers.
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                Author and article information

                Contributors
                Journal
                JMIR Res Protoc
                JMIR Res Protoc
                ResProt
                JMIR Research Protocols
                JMIR Publications (Toronto, Canada )
                1929-0748
                October 2021
                15 October 2021
                : 10
                : 10
                : e32911
                Affiliations
                [1 ] UniSA Clinical and Health Sciences Unit University of South Australia Adelaide Australia
                [2 ] Women's and Children's Hospital Women's and Children's Health Network Adelaide Australia
                [3 ] Refugee Health Service Central Adelaide Local Health Network Adelaide Australia
                Author notes
                Corresponding Author: Monica Pilar Diaz diamp001@ 123456mymail.unisa.edu.au
                Author information
                https://orcid.org/0000-0002-0128-2957
                https://orcid.org/0000-0002-0362-5693
                https://orcid.org/0000-0002-9170-8244
                https://orcid.org/0000-0001-6228-5636
                https://orcid.org/0000-0002-0552-0633
                Article
                v10i10e32911
                10.2196/32911
                8556634
                34652281
                f6f2d0d9-5370-4ba4-bfc0-9d6d3aa311b3
                ©Monica Pilar Diaz, Mary Steen, Angela Brown, Julie-Anne Fleet, Jan Williams. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 15.10.2021.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Research Protocols, is properly cited. The complete bibliographic information, a link to the original publication on https://www.researchprotocols.org, as well as this copyright and license information must be included.

                History
                : 15 August 2021
                : 19 August 2021
                Categories
                Protocol
                Protocol
                Custom metadata
                This paper was peer reviewed by University of South Australia. See the Multimedia Appendixes for the peer-review reports;

                education,midwives,nurses,female genital mutilation/cutting,maternity care,women’s health care, knowledge,attitude,practice

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