‘I stayed with my illness’: a grounded theory study of health seeking behaviour and treatment pathways of patients with obstetric fistula in Kenya

BMC Women's Health

Research Article

Isaac K. Nyamongo¹  Anne M. Khisa²  Grace M. Omoni³  Rachel F. Spitzer⁴ 

[1] University of Nairobi, Institute of Anthropology, Gender and African Studies, P.O. Box 30197-00100, Nairobi, Kenya;The Cooperative University of Kenya, Division of Cooperative Development, Research and Innovation, Box 24814-00502, Nairobi, PO, Kenya;University of Nairobi, School of Nursing Sciences, Box 11952-00100, Nairobi, PO, Kenya;University of Nairobi, School of Nursing Sciences, P.O Box 30197-00100, Nairobi, Kenya;University of Toronto, Dalla Lana School of Public Health, 155 College St. ON M57 3M7, Toronto, Canada;

关键词: Obstetric fistula;    Health seeking behaviour;    Grounded theory;    Narratives;    Kenya;   

DOI  :  10.1186/s12905-017-0451-6

 received in 2016-05-24, accepted in 2017-09-20,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundObstetric fistula classic symptoms of faecal and urinary incontinence cause women to live with social stigma, isolation, psychological trauma and lose their source of livelihoods. There is a paucity of studies on the health seeking behaviour trajectories of women with fistula illness although women live with the illness for decades before surgery. We set out to establish the complete picture of women’s health seeking behaviour using qualitative research. We sought to answer the question: what patterns of health seeking do women with obstetric fistula display in their quest for healing?MethodsWe used grounded theory methodology to analyse data from narratives of women during inpatient stay after fistula surgery in 3 hospitals in Kenya. Emergent themes contributed to generation of substantive theory and a conceptual framework on the health seeking behaviour of fistula patients.ResultsWe recruited 121 participants aged 17 to 62 years whose treatment pathways are presented. Participants delayed health seeking, living with fistula illness after their first encounter with unresponsive hospitals. The health seeking trajectory is characterized by long episodes of staying home with illness for decades and consulting multiple actors. Staying with fistula illness entailed health seeking through seven key actions of staying home, trying home remedies, consulting with private health care providers, Non-Governmental organisations, prayer, traditional medicine and formal hospitals and clinics. Long treatment trajectories at hospital resulted from multiple hospital visits and surgeries. Seeking treatment at hospital is the most popular step for most women after recognizing fistula symptoms.ConclusionsWe conclude that the formal health system is not responsive to women’s needs during fistula illness. Women suffer an illness with a chronic trajectory and seek alternative forms of care that are not ideally placed to treat fistula illness. The results suggest that a robust health system be provided with expertise and facilities to treat obstetric fistula to shorten women’s treatment pathways.

【 授权许可】

CC BY   
© The Author(s). 2017