Lavender T, Wakasiaka S, McGowan L, Moraa M, Omari J, Khisa W
Division of Nursing, Midwifery and Social Work, The University of Manchester, United Kingdom.
School of Nursing Sciences, University of Nairobi, Kenya.
Midwifery. 2016 Nov;42:54-60. doi: 10.1016/j.midw.2016.10.001. Epub 2016 Oct 4.
this study aimed to gain understanding of the views of community members in relation to obstetric fistula.
a qualitative, grounded theory approach was adopted. Data were collected using in-depth interviews with 45 community members. The constant comparison method enabled generation of codes and subsequent conceptualisations, from the data.
participants were from communities served by two hospitals in Kenya; Kisii and Kenyatta. Interviews took place either in the home, place of work, or hospital.
the core category (central concept) is 'secrecy hinders support'. This was supported by three themes: 'keeping fistula hidden', 'treatment being a lottery' and 'multiple barriers to support.' These themes represent the complexities around exposure of individual fistula sufferers and the impact that lack of information and women's status can have on treatment. Keeping fistula secret reinforces uncertainties around fistula, which in itself fuels myths and ignorance regarding causes and treatments. Lack of openness, at an individual level, prevents support being sought or offered.
A multi-layered strategy is required to support women with fistula. At a societal level, the status of women in LMIC countries needs elevation to a level that provides equity in health services. At a national level, laws need to protect vulnerable women from mistreatment as a direct result of fistula. Furthermore, resources should be available to ensure provision of timely management, as part of routine services. At community level, awareness and education is required to actively engage members to support women locally. Peer support before and after fistula repair may be beneficial, but requires further research.
本研究旨在了解社区成员对产科瘘的看法。
采用定性的扎根理论方法。通过对45名社区成员进行深入访谈收集数据。持续比较法有助于从数据中生成代码及后续的概念化内容。
参与者来自肯尼亚基苏木和肯雅塔两家医院所服务的社区。访谈在参与者家中、工作场所或医院进行。
核心类别（中心概念）是“保密阻碍支持”。这一观点得到三个主题的支持：“隐瞒瘘管病情”“治疗如同碰运气”以及“支持存在多重障碍”。这些主题体现了个体瘘管患者暴露病情方面的复杂性，以及信息匮乏和女性地位对治疗可能产生的影响。对瘘管病情保密加剧了围绕瘘管的不确定性，这本身又助长了关于病因和治疗方法的误解与无知。在个体层面缺乏坦诚公开的态度，使得人们无法寻求或提供支持。
需要采取多层次策略来支持患有瘘管的女性。在社会层面，低收入和中等收入国家的女性地位需要提升至能在卫生服务方面实现公平的水平。在国家层面，法律需要保护弱势女性不因瘘管病而直接遭受虐待。此外，应提供资源以确保作为常规服务的一部分能及时进行治疗。在社区层面，需要提高认识并开展教育，积极促使社区成员在当地支持女性。瘘管修复前后的同伴支持可能有益，但需要进一步研究。
