了解埃塞俄比亚产科瘘管病妇女的就医途径与困境：一项定性研究
Understanding Healthcare-Seeking Pathways and Dilemmas Among Women with Obstetric Fistulas in Ethiopia: A Qualitative Inquiry.
作者信息
Hurissa Bekana Fekecha, Koricha Zewdie Birhanu, Dadi Lelisa Sena
机构信息
School of Midwifery, Institute of Health, Jimma University, Jimma, Ethiopia.
Department of Health, Behavior, and Society, Faculty of Public Health, Jimma University, Jimma, Ethiopia.
出版信息
Int J Womens Health. 2023 Feb 3;15:135-150. doi: 10.2147/IJWH.S395064. eCollection 2023.
BACKGROUND
Obstetric fistula is a public health problem with a damaging effect on the health of women around the world. The path to medical care is an integral part of women's experience of illness that may have an impact on their health. Studies have addressed the experiences of patients after fistula repair, but fistula victims' care-seeking pathways and dilemmas are still poorly understood in low-income countries, particularly Ethiopia.
OBJECTIVE
This study aimed to explore the care-seeking pathways and dilemmas among women with fistulas in Ethiopia.
METHODS
An exploratory phenomenological study was carried out from April 1 to August 1, 2019, through in-depth interviews and supplementary informant interviews. Data were obtained from 21 purposively selected women with fistulas who survived with morbidity for one and more years and 12 supplementary interviewees at fistula treatment centers in Oromia Region and Addis Ababa. Data were analyzed assisted by ATLAS. ti 8.4 software.
RESULTS
Respondents gave their testimony that most of the women with fistulas first sought care from traditional care places and finally from fistula treatment centers. The reasons for care-seeking path dilemmas were a wrong perception about fistula, its causes, and treatment; families' pressure and lack of decision-making power on where to seek treatment, and a lack of knowledge on where modern treatments are available for fistula. They received psychological, companionship, and transport support from a family and a community; referral and counseling support from health care providers during their care-seeking pathways.
CONCLUSION
A myriad of reasons inhibits the right care-seeking pathways among women with fistulas. Communities and women with fistula awareness creation on the right places for fistula treatment and psychological support programs are required. Additionally, developing and implementing tactics for community-level screening programs for targeted victims and early admission to treatment centers can minimize the tragic sequela of the fistula.
背景
产科瘘是一个全球性的公共卫生问题，对世界各地妇女的健康造成了损害。就医途径是妇女患病经历的一个组成部分，可能会对她们的健康产生影响。已有研究探讨了瘘管修复术后患者的经历，但在低收入国家，尤其是埃塞俄比亚，瘘管受害者的就医途径和困境仍鲜为人知。
目的
本研究旨在探讨埃塞俄比亚瘘管病妇女的就医途径和困境。
方法
2019年4月1日至8月1日，通过深入访谈和补充 informant 访谈开展了一项探索性现象学研究。数据来自奥罗米亚地区和亚的斯亚贝巴瘘管治疗中心有目的地挑选的21名患有瘘管病且患病一年及以上的存活妇女，以及12名补充受访者。在 ATLAS.ti 8.4软件的辅助下对数据进行了分析。
结果
受访者证实，大多数瘘管病妇女最初是在传统护理场所寻求治疗，最终才前往瘘管治疗中心。就医途径困境的原因包括对瘘管病、其病因和治疗存在错误认知；家庭压力以及在何处寻求治疗方面缺乏决策权，以及对何处可获得瘘管病现代治疗方法缺乏了解。她们在就医过程中从家庭和社区获得了心理、陪伴和交通支持；从医疗保健提供者那里获得了转诊和咨询支持。
结论
多种原因阻碍了瘘管病妇女选择正确的就医途径。需要在社区和瘘管病妇女中开展关于瘘管病正确治疗场所的宣传以及心理支持项目。此外，制定和实施针对目标受害者的社区层面筛查项目策略并尽早将其送入治疗中心，可将瘘管病的悲惨后果降至最低。
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