Document Type


Date of Award


Degree Name

Doctor of Philosophy (PhD)




Background: Due to increasing transmigration, care of women with female genital cutting FGC has become a national and global public health and human rights issue. The US is one of the Western countries that have a large number of women who underwent or are at risk to undergo FGC. Based on the US Population Reference Bureau (PRB) (2013), there were more than 507,000 females with different migration status who were subjected to some form of FGC. Around 55% of these women were during their reproductive cycle (15 to 49 years old). Caring for immigrant women with FGC, especially those who are pregnant, is a key challenge in the American healthcare context. The challenge occurs as a result of health caregivers lacking knowledge and skills that sustain both the cultural and clinical components of perinatal care for immigrant women with FGC. Their lack of knowledge and skills marginalize this vulnerable group of women and often prevent them from accessing and utilizing current healthcare –perinatal- services. Avoiding seeking services increases the risk of having poorer health status among these women, which impacts negatively on their quality of life.

Purpose: The purpose of this research was to examine the impact of the FGC digital e-book on the level of the knowledge, attitude, and self-efficacy of undergraduate Baccalaureate nursing students in a public university located in Central New York State.

Methods: A pretest and posttest quasi-experimental design was conducted with a convenience sample of undergraduate nursing students in a public university located in Central New York State. Descriptive statistics were conducted to examine the demographic data of this study, and a dependent t-test was used to measure the mean differences at 95% CI of the level of attitude, knowledge, and self-efficacy before and after exposure to the FGC digital e-book. A 5 point Likert scale attitude scale was used to measure the participants’ attitudes regarding 13 statements of different aspects of FGC. The scale ranged from 13 to 65. The students’ FGC knowledge level was assessed by using a 3 point Likert FGC knowledge scale that has 14 close-ended questions with a total score ranges from 14 to 42. The students’ FGC self-efficacy level was examined by using a 3 point Likert scale that has 14 close-ended questions. The total scale score ranges from 14 to 42. Results: A total of 86 subjects were included in this study, females represented the largest sample group (87%). Around 89% (n = 76) of the study sample were 34 years of age or younger and the majority of the study sample were white (n = 59, 69.4%). Around 70% of the study sample knew about FGC before conducting the study, and 62.8% of them reported that someone told them about FGC but they had not witnessed it by themselves. The results suggesting that the FGC digital e-book significantly improves students’ attitudes (M(differences) = 5.47, SD = 8.275, [t(85) = 6.132, p < .001]); level of knowledge (M(differences) = 5.54, SD = 4.459, [t(85) = 11.520, p < .001]); and their self-efficacy (M (differences) = 6.37, SD = 5.16, [t(85) = 11.45, p < .001]). Pearson’s r coefficient correlation revealed a statistically significant positive moderate relationship between attitude and knowledge (r = 0.5, p = 0.000); however, there was no relationship between knowledge and self-efficacy variables (r = .047, p = 0.667) and attitude and self-efficacy (r = .173, p = 0.110).

Conclusion: Undergraduate nursing students who completed the FGC digital e-book had significantly improved scores on tests of attitude, knowledge, and self-efficacy regarding FGC. Improvements in these areas can be expected to optimize culturally and clinically competent nursing care for pregnant women who underwent FGC.

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Nursing Commons