Neonatal Male Circumcision: Examining Healthcare Providers' Practices

BACKGROUND: In the United States, circumcision is the most common surgical procedure performed on male infants (Updegrove, 2001). The decision to circumcise is multifactorial; religious, cultural, and traditional factors as well as medical indications influence parents’ decisions. Recent research demonstrates male circumcision’s protective effect against a variety of health conditions. The AAP and the CDC emphasized that healthcare providers are responsible for fostering informed decision-making processes for neonatal male circumcision (Blank et al., 2012; Smith et al., 2010). Currently, providers’ role and level of influence in this process has been largely unexplored. METHODS: The study employed a cross-sectional observational design using an explanatory sequential two-phase mixed methods approach to study healthcare providers’ neonatal male circumcision practices, beliefs, and knowledge. This study design incorporated a modified version of the Theory of Planned Behavior as a theoretical framework. The sample included healthcare providers from the family medicine, obstetrics, and pediatrics department from a urban medical center. RESULTS: The results revealed that there is significant variation amongst the healthcare providers in this study regarding practices, beliefs, and knowledge. For the knowledge items, providers reported low levels for items related to the newer circumcision research. The results supported the utility of the Theory of Planned Behavior to explain the factors that influences providers’ communicative practices; however, the construct of knowledge did not provide any additional explanation within the model. The providers reported that they are significantly more likely to discuss this procedure than compared with recommending and tailoring circumcision discussions with parent(s)/guardian(s). Providers believe they deliver a universal message when discussing neonatal male circumcision. However, the interview data suggests that providers are tailoring these messages based on their patients’ characteristics. The providers explain that parents’ decision to circumcise stem predominantly from cultural and traditional factors; medical indications play a minimal in the decision making process. CONCLUSIONS: An educational intervention is needed to increase providers’ level of knowledge regarding neonatal male circumcision to ensure that providers are effectively communicating factual information to parent(s)/guardian(s). Providers and parent(s)/guardian(s) should discuss all the factors that influence this decision collectively to foster informed decision making.