Table 4.

Results of REPLACE Approach Elements 1–3 and the Community Intervention Action implemented. (Source: REPLACE fieldwork, 2013–15)

FGM Affected Community	Stage of Readiness to End FGM prior to the implementation of the intervention	Main focus of intervention based on community engagement and CPAR	COM-B Assessment	Intervention Activity	Individual and community changes evident following the intervention	Stage of Readiness to End FGM following the implementation of the intervention
Eritrean/Ethiopian Community (Italy)	STAGE1–2: No community awareness of FGM mixed with denial and resistance.	Providing an opportunity to discuss issues associated with settling in the EU, including legal framework concerning FGM.	Low capability and motivation to address FGM and low opportunity, as this was a transient community, providing people with a greater sense of community and belonging was first step.	Organisation of a set of community sessions to bring community members together and raise awareness of FGM and the legal situation concerning FGM in the EU, as well as issues such as access to healthcare, housing and employment.	Increased awareness of health implications and legal situation concerning FGM in the EU. Efforts being made to create some community cohesion by organizing coffee mornings.	STAGE 2–3: Vague community awareness of FGM and no community motivation to end FGM mixed with denial and resistance.
Gambian/Senegalese Community (Spain)	STAGE 2: Community denial and resistance that FGM is an issue.	The link between gender inequality, poverty and FGM was identified with a need for inter-generational and inter-gender communication concerning FGM.	Opportunity for community discussions were identified as a significant obstacle. Community given advice and help in organizing community events by REPLACE partners to increase capability.	Organisation of a set of community sessions raising awareness of FGM focusing on the legal situation concerning FGM in the EU, gender equality and human rights. Provision of materials designed to increase ability to hold discussions	Raised awareness of issues associated with the legal framework concerning FGM in the EU. Raised awareness of the Human Rights debates concerning FGM. Encouraged changes in attitudes to family communication concerning FGM.	STAGE 3: Vague community awareness of FGM and no community motivation to end FGM.
Guinea Bissauan Community (Portugal)	STAGE 3: Vague awareness concerning FGM but no community motivation to tackle the issue.	The link between gender inequality, poverty and FGM was identified with a need for inter-generational and inter-gender communication concerning FGM.	Opportunity for community discussions were identified as a significant obstacle. Community given advice and help in organizing community events by REPLACE partners to increase capability.	Organisation of a set of community sessions focusing on attitudes towards European culture and FGM including health, religion, the law and gender equality. Provision of materials designed to increase ability to hold discussions	Raised awareness of issues associated with the legal framework concerning FGM in the EU. Raised awareness of the Human Rights debates concerning FGM. Encouraged changes in attitudes to family communication concerning FGM.	STAGE 4: Preplanning: there is community recognition that something must be done to end FGM but efforts lack focus.
Sudanese Community (UK)	STAGE 3: Vague awareness concerning FGM but no community motivation to tackle the issue.	Community regarded FGM Types I and II to be acceptable as the health impacts were perceived to be minimal. ‘little sunna’ (FGM Type I/II) believed to be a requirement of Islam.	Capability and opportunities were good, but community identified maintaining motivation as challenging.	Organisation of a community event to present sessions on the health consequences of FGM in particular Types I and I and challenging the belief that FGM is required by Islam. Break-out discussions in three languages.	Increased awareness of the health consequences of FGM Types I and II. Changes in attitudes towards perceived religious requirement to perform FGM Types I and II. Changing behaviour evidenced by group using regular lunch meetings and setting up a WhatsApp group to provide social support to maintain motivation and offer advice to members.	STAGE 4–5: There is a move towards planning activities and seeking resource to work with the community to end FGM.
Somali Community (Netherlands)	STAGE 4: Preplanning: there is community recognition that something must be done to end FGM but efforts lack focus.	Community identified that many members regarded ‘little sunna’ (FGM Type I/II) as a requirement of Islam and did not regard it as FGM.	Capability and motivation were identified as the main areas needing support. Training supplied by Islamic Scholar from a Dutch University supported by REPLACE partners.	Koranic school teachers developed and delivered a Koranic School lesson focusing on challenging the belief that FGM is required by Islam.	Changed attitudes towards the perceived imperative that FGM Type I was required by Islam. Change in behaviour evidenced by increased confidence to challenge religious social norms.	STAGE 4–5: There is a move towards planning activities and seeking resources to work with the community end FGM.