Beyond Repair: Family and Community Reintegration after Obstetric Fistula Surgery

无法修复：产科瘘手术后重新融入家庭和社区

• 批准号: 8730707
• 负责人: SUELLEN MILLER
• 金额: $ 14.52万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-09-05 至 2016-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8730707
• 关键词: Affect; Africa South of the Sahara; Area; Birth trauma; Car Phone; Caring; Cephalopelvic Disproportions; Clinical; Communities; Complement; Country; Development; Discipline of obstetrics; Economics; Emergency Situation; Evidence based program; Face; Family; Family Process; Fecal Incontinence; Feces; Fistula; Focus Groups; Foot-drop; Friends; Genital system; Goals; High Prevalence; Home environment; Husband; Individual; Infection; Infertility; Injury; Interview; Interviewer; Knowledge; Life Experience; Measurement; Measures; Methods; Mothers; Nerve; Obstetric Surgical Procedures; Operative Surgical Procedures; Outcome; Pain; Planet Mars; Population; Qualitative Research; Quality of life; Research; Respondent; Role; Rural; Sampling; Services; Structure; Technology; Testing; Uganda; Ulcer; Urine; Vagina; Validity and Reliability; Wife; Woman; cohort; community reintegration; experience; follow-up; indexing; knowledge base; neglect; programs; psychologic; psychosocial; public health relevance; repaired; scale up; success; tool; urinary

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.

描述（由申请人提供）：产科瘘是一种令人衰弱的出生伤害，影响了估计2至300万妇女，大多数在撒哈拉以南非洲。具有产科瘘管的妇女由于不断泄漏尿液和粪便而遭受严重的身体伤害和毁灭性的心理影响。在过去的十年中，越来越多的努力来扩大瘘管服务，但是先前对瘘管修复结果的研究主要集中在临床结果上，而没有考虑该女性重新融入她的家庭和社区的成功。理解重新融合的重要一步是开发适当的测量工具，因为目前不存在。这项研究的目的是更好地了解瘘管手术后家庭和社区重返社会的过程；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区的长期成功，并评估该组中使用手机技术的长期随访的可行性。使用深入的个人访谈，我们将进行形成性研究，以了解瘘管修复后返回社区的妇女的生活经验。这种理解将为我们使用焦点小组的使用来确定与重新融合相关的领域。然后，我们将使用这些领域修改已有的测量工具，并在瘘管手术后12个月后立即在60名乌干达妇女中进行试验该工具。该措施的因素结构，可靠性和有效性将建立。纵向样本中的后续措施将利用移动细胞技术；这种后续方法的成功将由我们的项目面试官和受访者评估。这是开发一种可靠有效的工具的早期一步，用于衡量家庭和社区重返术后手术的成功，并补充其他节目以增加手术的数量。随着越来越多的瘘管修复，至关重要的是要超越修复，了解妇女的生活经历，以及我们如何在手术后改善妇女的家庭和社区重返社会。拟议的研究集中在被忽视的地区，将加速新的后赛后维修测量工具以遵循重新整合，对越来越多的瘘管维修妇女进行基于循证的编程具有重要意义，并将为通过移动技术进行随访的知识基础。此外，这是在乌干达进行的第一项此类研究，这是一个乌干达，一个具有高产瘘管的国家，将有助于辨别这些妇女的生活经历及其在这种特殊的文化和政治背景下的生活经历。