'I stayed with my illness': a grounded theory study of health seeking behaviour and treatment pathways of patients with obstetric fistula in Kenya
'I stayed with my illness': a grounded theory study of health seeking behaviour and treatment pathways of patients with obstetric fistula in Kenya
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DOI：
10.1186/s12905-017-0451-6
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发表时间：
2017-09-29
影响因子：
2.5
通讯作者：
Spitzer, Rachel F.
中科院分区：
文献类型：
--
作者：
Khisa, Anne M.;Omoni, Grace M.;Spitzer, Rachel F.
背景资料：大便失禁和尿失禁的典型症状使妇女生活在社会耻辱、孤立、心理创伤中，并失去生计来源。关于瘘管病妇女求医行为轨迹的研究很少，尽管妇女在手术前已患病数十年。我们开始建立妇女的健康寻求行为的定性研究的全貌。我们试图回答这样一个问题：患有产科瘘管病的妇女在寻求治愈时表现出什么样的保健模式？研究方法：我们使用扎根理论方法分析肯尼亚3家医院瘘管手术后住院期间妇女的叙述数据。出现的主题有助于产生实质性的理论和概念框架上的健康寻求行为的fistula patients.Results：我们招募了121名参与者，年龄在17至62岁的治疗途径。参与者推迟了就医，在第一次遇到反应迟钝的医院后患有瘘管病。寻求健康的轨迹的特点是长期患病在家数十年，并咨询多个行为者。与瘘管病共存需要通过以下七项关键行动寻求健康：呆在家里、尝试家庭疗法、咨询私人保健提供者、非政府组织、祈祷、传统医学和正规医院和诊所。医院的长期治疗轨迹是由于多次医院就诊和手术。在医院寻求治疗是最受欢迎的步骤，大多数妇女后，认识到瘘管symptoms.Conclusions：我们的结论是，正式的卫生系统是不响应妇女的需求，在瘘管病。妇女患有慢性疾病，并寻求替代护理形式，但这些形式并不适合治疗瘘管病。研究结果表明，应建立一个强有力的卫生系统，提供专门知识和设施来治疗产科瘘管病，以缩短妇女的治疗途径。
Background: Obstetric fistula classic symptoms of faecal and urinary incontinence cause women to live with social stigma, isolation, psychological trauma and lose their source of livelihoods. There is a paucity of studies on the health seeking behaviour trajectories of women with fistula illness although women live with the illness for decades before surgery. We set out to establish the complete picture of women's health seeking behaviour using qualitative research. We sought to answer the question: what patterns of health seeking do women with obstetric fistula display in their quest for healing?Methods: We used grounded theory methodology to analyse data from narratives of women during inpatient stay after fistula surgery in 3 hospitals in Kenya. Emergent themes contributed to generation of substantive theory and a conceptual framework on the health seeking behaviour of fistula patients.Results: We recruited 121 participants aged 17 to 62 years whose treatment pathways are presented. Participants delayed health seeking, living with fistula illness after their first encounter with unresponsive hospitals. The health seeking trajectory is characterized by long episodes of staying home with illness for decades and consulting multiple actors. Staying with fistula illness entailed health seeking through seven key actions of staying home, trying home remedies, consulting with private health care providers, Non-Governmental organisations, prayer, traditional medicine and formal hospitals and clinics. Long treatment trajectories at hospital resulted from multiple hospital visits and surgeries. Seeking treatment at hospital is the most popular step for most women after recognizing fistula symptoms.Conclusions: We conclude that the formal health system is not responsive to women's needs during fistula illness. Women suffer an illness with a chronic trajectory and seek alternative forms of care that are not ideally placed to treat fistula illness. The results suggest that a robust health system be provided with expertise and facilities to treat obstetric fistula to shorten women's treatment pathways.