title: Development of an intervention to improve mental health for obstetric fistula patients in Tanzania.
abstract: Obstetric fistula is a debilitating childbirth injury that has been associated with high rates of psychological distress. Global efforts have helped to link women to surgical repair, but thus far no evidence-based interventions exist to address the psychological needs of these women during the hospital stay. In this paper, we describe the development of a psychological intervention for women in Tanzania who are receiving surgical care for an obstetric fistula. The intervention was developed based on theories of cognitive behavioral therapy and coping models. Content and delivery were informed by qualitative data collection with a range of stakeholders including women with fistula, and input from a study advisory board. The resulting intervention was six individual sessions, delivered by a trained community health nurse. The session topics were (1) recounting the fistula story; (2) creating a new story about the fistula; (3) loss, grief and shame; (4) specific strategies for coping; (5) social relationships; and (6) planning for the future. A trial run of the intervention revealed that the intervention could be delivered with fidelity and was acceptable to patients. A future randomized control trial will evaluate the efficacy of this intervention to address the mental health symptoms of this population.
authors.affiliation: Duke Global Health Institute, Durham, NC, USA. Electronic address: melissa.watt@duke.edu.
authors.forename: Melissa H
authors.initials: MH
authors.lastname: Watt
authors.affiliation: Duke Global Health Institute, Durham, NC, USA; Department of Psychology and Neuroscience, Duke University, Durham, NC, USA.
authors.forename: Sarah M
authors.initials: SM
authors.lastname: Wilson
authors.affiliation: Duke Global Health Institute, Durham, NC, USA; Department of Psychology and Neuroscience, Duke University, Durham, NC, USA.
authors.forename: Kathleen J
authors.initials: KJ
authors.lastname: Sikkema
authors.affiliation: Duke Global Health Institute, Durham, NC, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Velloza
authors.affiliation: Department of Obstetrics and Gynecology, Kilimanjaro Christian Medical Centre, Moshi, Tanzania.
authors.forename: Mary V
authors.initials: MV
authors.lastname: Mosha
authors.affiliation: Department of Obstetrics and Gynecology, Kilimanjaro Christian Medical Centre, Moshi, Tanzania.
authors.forename: Gileard G
authors.initials: GG
authors.lastname: Masenga
authors.affiliation: Maternity Africa, Arusha, Tanzania.
authors.forename: Margaret
authors.initials: M
authors.lastname: Bangser
authors.affiliation: Maternity Africa, Arusha, Tanzania; Selian Lutheran Hospital, Arusha, Tanzania.
authors.forename: Andrew
authors.initials: A
authors.lastname: Browning
authors.affiliation: Department of Obstetrics and Gynecology, Kilimanjaro Christian Medical Centre, Moshi, Tanzania.
authors.forename: Pilli M
authors.initials: PM
authors.lastname: Nyindo
mesh_terms: D000046:Academic Medical Centers; D000223:Adaptation, Psychological; D000293:Adolescent; D000328:Adult; D026683:Advisory Committees; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003152:Community Health Nursing; D003376:Counseling / Q000379:methods*; D005260:Female; D017144:Focus Groups; D006801:Humans; D007400:Interprofessional Relations; D008603:Mental Health; D009657:North Carolina; D009774:Obstetrics; D017060:Patient Satisfaction; D010865:Pilot Projects; D016730:Program Development; D013636:Tanzania; D014624:Vaginal Fistula / Q000523:psychology* / Q000601:surgery; D055815:Young Adult
keywords: Cognitive behavioral therapy; Maternal health; Mental health; Obstetric fistula; Tanzania