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Table 2 Thematic analysis of enablers and disablers of reintegration and regaining normalcy

From: A grounded theory of regaining normalcy and reintegration of women with obstetric fistula in Kenya

First order category/ theme Second order category/ theme Category full description Third order category/subtheme
Reintegration and regaining normalcy Positive social capital & interactions Participants social interactions post fistula surgery. Women who had greater social capital with positive social interactions deemed themselves to be regaining a normal life and previously meaningful social status which they had lost during the illness. - Being accepted and supported by family
- Being accepted and supported by spouse
- Being accepted and supported by community
  Continence and physical health How participants perceive their physical health. Being continent of urine or faecal matter (successful closure of fistula with no leakage of urine or faeces) placed a patient on a new pedestal, removing the hygiene challenges they had before. - Urine / faecal continence
- Perception of physical health
- Expectations of surgery
Performance of gender roles How a women perform roles expected of them as women in the community. They discussed their roles in relation with their physical condition after surgery, and the coping with the discharge instructions of avoiding manual work.
Women who can perform gender roles as expected by society had better outlook towards regaining their normal life after surgery. Gender role insufficiency occurred when women couldn’t fulfil their expected gender roles perceiving themselves as not yet regained normal life.
- Conducting household chores of fecthing water, cooking, sweeping
- returning to the farm
- Selling goods in the market
- Observing discharge instructions to avoid strenous work for 6 months
Ability to conceive and bear a child Return to full reproductive function, in terms of being able to give birth and achieve the previously disrupted life goal of motherhood.
Includes tension between participants’ desire to give birth soon after surgery (and often the stillbirth during the index birth at fistula) and adhering to discharge instructions of abstinence for 6 months post surgery and postponing conception until after two years.
- Observing discharge instructions to abstain from sexual intercourse for 6 months
- Fertility concerns
- Perception of and / or using family planning
Economic independence Having a form of economic independence, and obtaining a form of skill training was relieving to women who, during the fistula illness, had to rely on relatives for provisions and sustenance during the illness.
Dependence for sustenance - Emergent theme in participant’s narratives, of women having to depend on kin and well-wishers for their basic needs after surgery.
- Having own business
- Ability to conduct previous income generating activities like farming or selling in the market
- Obtaining sewing skills training and machines as part of reintegration support
Marital stability Retaining a marriage that was stable with a supportive husband or spouse seemed to bear fruit in psychological and social support, and the possibility of still trying for pregnancy and a child.
Women who experience periods of separation from the spouse or even divorce as a result of fistula illness or as a coping mechanism to adhere to discharge instructions of abstinence, experience a negative perception of regaining normal lives.
- Psychological and social support by spouse
- Living in marital home
- Observing discharge instructions to abstain from sexual intercourse for 6 months
- Hope for conceiving again
- Divorce and separation
Mental wellbeing Participants psychological and emotional thoughts describing suicidal thoughts.
Being in a state of mental wellbeing, devoid of stress or anxiety related to fistula illness was beneficial to the process of regaining normalcy.
- Receiving psychological support
- Having suicidal thoughts
- Mental agony and distress