Comprehensive Reintegration Assistance for Women with Obstetric Fistula

 这个独立之路奖（K99/R 00）的目标是促进我成为一名独立的科学家，对影响孕产妇健康差异的结构，社会和人际因素进行创新的流行病学研究，并将这项研究转化为预防和治疗孕产妇发病率和死亡率的具体方法。拟议的研究活动针对产科瘘管病，这是一种研究不足的创伤性分娩伤害，影响全球约200万至300万妇女[1]。强迫症具有广泛的生理和心理影响，患有强迫症的妇女受到严重的侮辱和边缘化。尽管手术在临床上取得成功，但身体残疾和精神健康状况不佳可能持续存在，使妇女难以重新融入家庭和社区。我的工作重点是手术后重返社会，这是及时的，因为接受手术的机会增加了，但没有同时制定循证重返社会方案。为了解决这一差距，在该奖项的指导阶段（K99）计划的培训和研究活动将建立在我的能力，使我具备必要的知识和技能：1）社会心理健康理论和方法; 2）混合方法研究; 3）纵向数据分析的先进定量方法;和4）干预开发。这些活动中的每一项都将有助于我成功地进入本申请的独立阶段（R 00），其目的是：1）对关于OF和类似条件的重返社会规划的已发表文献和灰色文献进行系统审查; 2）设计一个后-通过与主要利益攸关方反复合作，对妇女及其家庭进行手术重返社会干预，以改善妇女的心理和身体康复;以及3）使用队列对照设计对目标2中开发的干预进行试点，并测量其可行性、可接受性和对术后重返成功的初步影响。我的导师和咨询团队是独一无二的，以帮助我实现我的培训和研究目标，并确保我过渡到成功的独立调查员。这一准备性研究、干预措施开发和试点测试将为R 01奠定基础，R 01将在规模和随访时间长度方面扩大该试验，以评估干预措施对妇女手术后重返社会、身心残疾和经济状况的有效性。

 DESCRIPTION (provided by applicant): The goal of this Pathway to Independence Award (K99/R00) is to facilitate my transition to becoming an independent scientist carrying out innovative epidemiologic research on the structural, social, and interpersonal factors influencing maternal health disparities, and translate this research into tangible approaches for the prevention and treatment of maternal morbidity and mortality. The research activities proposed target obstetric fistula, an under-researched traumatic birth injury that affects an estimated 2-3 million women globally [1]. OF has broad physical and psychosocial ramifications, and women with OF are severely stigmatized and marginalized. Despite clinically successful surgery, physical disabilities and poor mental health may persist, making reintegration to family and community difficult for women. The post-surgical reintegration focus of my work is timely, as access to surgery has increased without parallel development of evidence-based reintegration programming. To address this gap, the training and research activities planned during the mentored phase of this award (K99) will build upon my capabilities to equip me with the necessary knowledge and skills in: 1) social-psychological health theories and methodologies; 2) mixed-methods research; 3) advanced quantitative methods for the analysis of longitudinal data; and 4) intervention development. Each of these activities will be instrumental to my successful advancement to the independent phase (R00) of this application, the aims of which are: 1) To conduct a systematic review of the published and grey literature on reintegration programming for OF and analogous conditions; 2) To design a post-surgical reintegration intervention for women and their households to improve women's psychosocial and physical recovery through iterative work with key stakeholders; and 3) To pilot the intervention developed in Aim 2 using a cohort- controlled design and measure the feasibility, acceptability and preliminary impact on post-surgical reintegration success. My mentorship and consulting team is uniquely poised to assist me in achieving my training and research goals, and ensure my transition to success as an independent investigator. This preparatory research, intervention development and pilot testing will lay the groundwork for an R01 which will expand this trial both in size and length of follow-up time in order to evaluate the effectiveness of the intervention on women's post-surgical reintegration, physical and mental disabilities, and economic status.