Beyond Repair: Family and Community Reintegration after Obstetric Fistula Surgery

描述（由申请人提供）：产科瘘是一种使人衰弱的分娩损伤，估计影响200万至300万妇女，大多数在撒哈拉以南非洲。患有产科瘘管病的妇女由于经常漏尿和粪便而遭受严重的身体伤害和毁灭性的心理影响。过去十年见证了越来越多的努力扩大瘘管服务，然而，以前的研究瘘管修复结果主要集中在临床结果，而没有考虑妇女重新融入家庭和社区的成功。了解重新整合的一个重要步骤是开发一个适当的度量工具，因为目前还没有这样的工具。本研究的目的是为了更好地了解瘘手术后家庭和社区重新融入的过程；修改和试点测试一种测量工具，以评估瘘管手术后妇女家庭和社区重返社会的长期成功，并评估利用移动电话技术对该群体进行长期随访的可行性。通过深入的个人访谈，我们将进行形成性研究，以了解瘘修复后返回社区的妇女的生活经验。这种理解将有助于我们利用焦点小组来确定与重返社会有关的领域。然后，我们将使用这些域来修改现有的测量工具，并在60名乌干达妇女中对该工具进行试点测试，这些妇女在瘘管手术后12个月内立即接受手术。建立该量表的因素结构、信度和效度。纵向样本之间的后续将利用移动蜂窝技术；这种跟踪方法的成功与否将由我们的项目面试官和受访者进行评估。这是朝着开发一种可靠有效的工具来衡量瘘管手术后家庭和社区重返社会的成功迈出的早期一步，并补充了增加手术数量的其他规划。随着越来越多的瘘管得到修复，有必要超越修复，了解妇女的生活经历，以及我们如何在手术后加强妇女的家庭和社区重返社会。拟议的研究侧重于一个被忽视的领域，将加速开发一种新的瘘道修复后测量工具，以跟踪重新融入，对为越来越多的瘘道修复妇女制定循证规划具有重要意义，并将有助于通过移动技术对农村居民进行随访的知识库。此外，这是在产科瘘管病高发的乌干达进行的第一次此类研究，将有助于了解这些妇女的生活经历及其在这种特殊文化和政治背景下的需求。

DESCRIPTION (provided by applicant): Obstetric fistula is a debilitating birth injury that affects an estimated 2 to 3 million women, most in sub- Saharan Africa. Women with obstetric fistula suffer from severe physical injuries and devastating psychological effects due to constantly leaking urine and feces. The past decade has witnessed increasing efforts to scale up fistula services, however previous research on fistula repair outcomes have focused primarily on clinical outcomes without considering the success of the woman's reintegration into her family and community. An essential step toward understanding reintegration is to develop an appropriate measurement tool, as none currently exist. The aims of this study are to better understand the process of family and community reintegration post fistula surgery; to modify and pilot test a measurement tool to assess long term success of family and community reintegration among women post fistula surgery, and to assess the feasibility of long-term follow-up among this group utilizing mobile phone technology. Using in-depth individual interviews we will conduct formative research to understand the lived experience of women who have returned to their communities after fistula repair. This understanding will inform our use of focus groups to identify domains relevant to reintegration. We will then use these domains to modify a pre-existing measurement tool, and pilot test this tool among a cohort of 60 Ugandan women immediately following fistula surgery through 12 months post-surgery. The factor structure, reliability and validity of this measure will be established. Follow-up among the longitudinal sample will utilize mobile cellular technology; the success of this method of follow-up will be evaluated by our project interviewer and respondents. This is an early step towards developing a reliable and valid tool for measuring the success of family and community reintegration post-fistula surgery, and complements other programming to increase the number of surgeries. As more fistulas are repaired, it is essential to move beyond repair and to understand women's lived experiences and how we can enhance women's family and community reintegration post-surgery. The proposed research focuses on a neglected area, will accelerate the development of a new post-fistula repair measurement tool to follow re-integration, has important implications for developing evidence-based programming for a growing population of women with fistula repair, and will contribute to the knowledge base on follow-up of rural inhabitants via mobile technology. Furthermore, the fact that this is the first study of its kind to occur in Uganda, a country with a high prevalence of obstetric fistula, will help to discern the lived experiences of these women and their needs within this particular cultural and political context.