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）：产科瘘管病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不断漏尿和漏粪，遭受严重的身体伤害和毁灭性的心理影响。在过去十年中，人们越来越多地努力扩大瘘管病服务的规模，但以前关于瘘管病修复结果的研究主要侧重于临床结果，而没有考虑妇女是否成功地重新融入家庭和社区。理解重返社会的一个重要步骤是制定一个适当的衡量工具，因为目前还不存在。这项研究的目的是更好地了解瘘管病手术后重返家庭和社区的过程;修改和试点测试一种衡量工具，以评估瘘管病手术后妇女重返家庭和社区的长期成功，并评估利用移动的电话技术对这一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，以了解瘘管修复后返回社区的妇女的生活经历。这种理解将为我们利用重点小组确定与重返社会有关的领域提供信息。然后，我们将使用这些域来修改现有的测量工具，并在瘘管手术后立即到手术后12个月内在60名乌干达妇女中对该工具进行试点测试。本研究将建立该量表的因素结构、信度和效度。纵向样本的随访将利用移动的蜂窝技术;这种随访方法的成功将由我们的项目访谈者和受访者进行评估。这是朝着开发一个可靠有效的工具来衡量瘘管病手术后重返家庭和社区的成功程度迈出的早期步骤，并补充了其他方案，以增加手术数量。随着越来越多的瘘管得到修复，至关重要的是要超越修复，了解妇女的生活经历，以及我们如何才能加强妇女手术后重返家庭和社区。拟议的研究侧重于一个被忽视的领域，将加快开发一种新的瘘管修补后测量工具，以跟踪重新融入社会的情况，对为越来越多的瘘管修补妇女制定循证方案具有重要意义，并将通过移动的技术促进建立关于农村居民后续行动的知识库。此外，这是在乌干达这个产科瘘管病高发国家进行的第一次此类研究，这将有助于了解这些妇女的生活经历及其在这一特定文化和政治背景下的需求。