University of Nairobi, School of Nursing Sciences, P.O. Box 30197-00100, Nairobi, Kenya.
African Population and Health Research Centre, P.O. Box 10787-00100, Nairobi, Kenya.
Reprod Health. 2019 Mar 8;16(1):29. doi: 10.1186/s12978-019-0692-y.
Obstetric fistula is a reproductive health problem causing immense suffering to 1% of women in Kenya that is formed as sequelae of prolonged obstructed labour. It is a chronic illness that disrupts women lives, causing stigma and isolation. Fistula illness often introduces a crisis in women's life begetting feelings of shame and serious disruption to their social, psychological, physical and economic lives, in addition to dealing with moral and hygiene challenges. Currently, women undergo free of charge surgery at vesicovaginal fistula (VVF) camps held in national referral hospitals and dedicated fistula centres generating a significant pool of women who have undergone surgery and are ready to regain normal lives.
The purpose of this study was to explore experiences of women immersing back into communities and their return to normalcy after surgery in three VVF repair centres in Kenya. We set out to answer the question: what strategies improve obstetric fistula patients' reintegration process?
We used grounded theory methodology to capture the reintegration and regaining normalcy experiences of women after surgery. Narrative interviews were held with 60 women during community follow-up visits in their homes after 6-19 months postoperatively. Grounded theory processes of theoretical sampling, repeated measurement; constant comparative coding in three stage open, axial and selective coding; memoing, reflexivity and positionality were applied. Emergent themes helped generate a grounded theory of reintegration and regaining normalcy for fistula patients.
To regain normal healthy lives, women respond to fistula illness by seeking surgery.. After surgery, four possible outcomes of the reintegration process present; reintegration fully or partially back into their previous communities, not reintegrated or newly integrating away from previous social and family settings. The reintegration statuses point to the diversity outcomes of care for fistula patients and the necessity of tailoring treatment programs to cater for individual patient needs.
The emerging substantive theory on the process of reintegration and regaining normalcy for fistula patients is presented. The study findings have implications for fistula care, training and policy regarding women's health, suggesting a model of care that encompasses physical, social, economic and psychological aspects of care after surgery and discharge.
产科瘘是一种生殖健康问题，在肯尼亚，1%的女性深受其害，它是由长时间难产导致的后遗症。这是一种慢性疾病，扰乱了女性的生活，给她们带来耻辱感和孤立感。瘘病常常给女性的生活带来危机，使她们感到羞耻，并严重扰乱她们的社会、心理、身体和经济生活，此外还面临道德和卫生方面的挑战。目前，女性在国家转诊医院和专门的瘘管中心举办的免费膀胱阴道瘘（VVF）营地接受手术，这为已经接受手术并准备恢复正常生活的大量女性提供了机会。
本研究旨在探讨肯尼亚三个 VVF 修复中心的女性重返社区和术后恢复正常生活的经历。我们旨在回答以下问题：哪些策略可以改善产科瘘患者的重返社会过程？
我们使用扎根理论方法来捕捉女性术后重返社会和恢复正常生活的经历。在术后 6-19 个月，对 60 名女性进行了家庭随访中的叙事访谈。扎根理论的过程包括理论抽样、重复测量、三阶段开放式、轴向和选择性编码的反复编码；记笔记、反思和定位。出现的主题有助于为瘘管患者的重新融入和恢复正常生活生成一个扎根理论。
为了恢复正常健康的生活，女性会因瘘病寻求手术。手术后，重新融入过程可能会出现四种结果；完全或部分重新融入以前的社区，无法重新融入或新的社会和家庭环境中重新融入。重新融入的状态表明了对瘘管患者护理的多样性结果，以及根据患者个体需求定制治疗方案的必要性。
提出了关于瘘管患者重新融入和恢复正常生活过程的新兴实质性理论。研究结果对瘘管护理、培训和妇女健康政策具有启示意义，表明手术后和出院后的护理模式应包括身体、社会、经济和心理方面的护理。
