title: Secrecy inhibits support: A grounded theory of community perspectives of women suffering from obstetric fistula, in Kenya.
abstract: OBJECTIVE
  this study aimed to gain understanding of the views of community members in relation to obstetric fistula.
  
  
  METHODS
  a qualitative, grounded theory approach was adopted. Data were collected using in-depth interviews with 45 community members. The constant comparison method enabled generation of codes and subsequent conceptualisations, from the data.
  
  
  METHODS
  participants were from communities served by two hospitals in Kenya; Kisii and Kenyatta. Interviews took place either in the home, place of work, or hospital.
  
  
  RESULTS
  the core category (central concept) is 'secrecy hinders support'. This was supported by three themes: 'keeping fistula hidden', 'treatment being a lottery' and 'multiple barriers to support.' These themes represent the complexities around exposure of individual fistula sufferers and the impact that lack of information and women's status can have on treatment. Keeping fistula secret reinforces uncertainties around fistula, which in itself fuels myths and ignorance regarding causes and treatments. Lack of openness, at an individual level, prevents support being sought or offered.
  
  
  CONCLUSIONS
  A multi-layered strategy is required to support women with fistula. At a societal level, the status of women in LMIC countries needs elevation to a level that provides equity in health services. At a national level, laws need to protect vulnerable women from mistreatment as a direct result of fistula. Furthermore, resources should be available to ensure provision of timely management, as part of routine services. At community level, awareness and education is required to actively engage members to support women locally. Peer support before and after fistula repair may be beneficial, but requires further research.
authors: Division of Nursing, Midwifery and Social Work, The University of Manchester, United Kingdom. Electronic address: Tina.lavender@manchester.ac.uk.
authors: T
authors: T
authors: Lavender
authors: School of Nursing Sciences, University of Nairobi, Kenya.
authors: S
authors: S
authors: Wakasiaka
authors: Faculty of Medicine and Health, The University of Leeds, United Kingdom.
authors: L
authors: L
authors: McGowan
authors: Kissi Hospital, Kissi County, Kenya.
authors: M
authors: M
authors: Moraa
authors: Kissi Hospital, Kissi County, Kenya.
authors: J
authors: J
authors: Omari
authors: Division of Nursing, Midwifery and Social Work, The University of Manchester, United Kingdom; Kenyatta National Hospital, Department of Obs/Gynae, Nairobi, Kenya.
authors: W
authors: W
authors: Khisa
mesh_terms: D000328:Adult; D005260:Female; D066296:Grounded Theory; D006297:Health Services Accessibility; D006801:Humans; D007407:Interviews as Topic; D007630:Kenya; D008297:Male; D008875:Middle Aged; D007744:Obstetric Labor Complications / Q000523:psychology*; D011247:Pregnancy; D036301:Qualitative Research; D011787:Quality of Health Care; D011788:Quality of Life / Q000523:psychology*; D012006:Rectovaginal Fistula / Q000523:psychology*; D057545:Social Stigma; D014521:Urethra / Q000293:injuries; D014549:Urinary Incontinence / Q000209:etiology; D014719:Vesicovaginal Fistula / Q000150:complications / Q000523:psychology*; D055815:Young Adult
keywords: Community; Fistula; Grounded theory; Obstetric; Qualitative; Support