Pelvic Organ Prolapse Management in Nepalese Women: an Exploration of Factors Effecting Quality of Life and Implications for Policy and Practice

Singh, Anjana (2019) Pelvic Organ Prolapse Management in Nepalese Women: an Exploration of Factors Effecting Quality of Life and Implications for Policy and Practice. Doctoral thesis, Northumbria University.

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Abstract

Pelvic organ prolapse (POP) is a major reproductive health problem in developing countries like Nepal. The government has addressed the problem by initiating free surgical camps. However, different issues related to the paternalistic mode of management raise questions about the effectiveness of this approach. For a successful outcome, the problem needs to be assessed and treated considering different quality of life (QOL) domains. In order to arrive at a solution to manage POP in Nepal that places the person at the centre of care (person-centred care, PCC), multiple ways of understanding the effectiveness are needed which include the voices of women and the voices of clinicians.

A qualitative methodology, based on an interpretivist approach was used in this study. This study explores the views of women who experienced POP management together with the clinician’s views involved in the management of POP. The impact of POP, on QOL before and after its management forms the central focus for evaluating effectiveness. Fourteen one-to-one interviews and two focus group discussions were conducted. Narratives were obtained from the women about the experiences of living with POP as well as life after its management. Similarly, narrative accounts of POP management were obtained from the clinicians. These narratives from the two groups of participants were analysed using the framework analysis technique.

This thesis highlights that the position of women in society was an important factor contributing to the development of POP amongst Nepalese women. Poverty, lack of education and socio-cultural disempowerment together with lack of access to a health care facilities were associated factors leading to delays in seeking timely health care. POP has been found to hamper the QOL for women significantly. The physical domain was the main domain effected above all other domains. Correction of physical symptoms was found to be associated with an improved QOL for women. The favoured clinical initiatives taken for the treatment of POP, though paternalistic, seemed successful as surgery for POP was found to be associated with an improvement in QOL for the majority of women. However, the management approach needs to be refocused on PCC in order to improve the overall lives of the women. Such a shift to PCC will require practice development at every level of its management. There is an urgent need to develop knowledgeable and skilled manpower both in curative and preventive care of POP. Integration of preventive aspects of POP management, within the government health care system, is a key factor if sustainable improvements are to be achieved.

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