Development and preliminary validation of a post-fistula repair reintegration instrument among Ugandan women

Alison El Ayadi, Hadija Nalubwama, Justus Barageine, Torsten B Neilands, Susan Obore, Josaphat Byamugisha, Othman Kakaire, Haruna Mwanje, Abner Korn, Felicia Lester, Suellen Miller, Alison El Ayadi, Hadija Nalubwama, Justus Barageine, Torsten B Neilands, Susan Obore, Josaphat Byamugisha, Othman Kakaire, Haruna Mwanje, Abner Korn, Felicia Lester, Suellen Miller

Abstract

Background: Obstetric fistula is a debilitating and traumatic birth injury affecting 2-3 million women globally, mostly in sub-Saharan Africa and Asia. Affected women suffer physically, psychologically and socioeconomically. International efforts have increased access to surgical treatment, yet attention to a holistic outcome of post-surgical rehabilitation is nascent. We sought to develop and pilot test a measurement instrument to assess post-surgical family and community reintegration.

Methods: We conducted an exploratory sequential mixed-methods study, beginning with 16 in-depth interviews and four focus group discussions with 17 women who underwent fistula surgery within two previous years to inform measure development. The draft instrument was validated in a longitudinal cohort of 60 women recovering from fistula surgery. Qualitative data were analyzed through thematic analysis. Socio-demographic characteristics were described using one-way frequency tables. We used exploratory factor analysis to determine the latent structure of the scale, then tested the fit of a single higher-order latent factor. We evaluated internal consistency and temporal stability reliability through Raykov's ρ and Pearson's correlation coefficient, respectively. We estimated a series of linear regression models to explore associations between the standardized reintegration measure and validated scales representing theoretically related constructs.

Results: Themes central to women's experiences following surgery included resuming mobility, increasing social interaction, improved self-esteem, reduction of internalized stigma, resuming work, meeting their own needs and the needs of dependents, meeting other expected and desired roles, and negotiating larger life issues. We expanded the Return to Normal Living Index to reflect these themes. Exploratory factor analysis suggested a four-factor structure, titled 'Mobility and social engagement', 'Meeting family needs', 'Comfort with relationships', and 'General life satisfaction', and goodness of fit statistics supported a higher-order latent variable of 'Reintegration.' Reintegration score correlated significantly with quality of life, depression, self-esteem, stigma, and social support in theoretically expected directions.

Conclusion: As more women undergo surgical treatment for obstetric fistula, attention to the post-repair period is imperative. This preliminary validation of a reintegration instrument represents a first step toward improving measurement of post-surgical reintegration and has important implications for the evidence base of post-surgical reintegration epidemiology and the development and evaluation of fistula programming.

Keywords: Instrument; Maternal morbidity; Measure; Obstetric fistula; Obstructed labor; Social reintegration; Uganda.

Conflict of interest statement

Ethics approval and consent to participate

The study protocol was approved by the Makerere University School of Medicine, College of Health Sciences Research Ethics Committee (Ref# 2014–052) and the University of California, San Francisco Human Research Protection Program, Committee on Human Research (IRB# 12–09573). All individuals eligible for the research underwent an informed consent process; those individuals unable to provide signature for informed consent provided thumbprint confirmation.

Consent for publication

N/A

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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