The goal of this Pathway to Independence Award (K99/R00) is to facilitate my transition to becoming an independent scientist carrying out innovative epidemiologic research on the structural, social, and interpersonal factors influencing maternal health disparities, and translate this research into tangible approaches for the prevention and treatment of maternal morbidity and mortality. The research activities proposed target obstetric fistula, an under-researched traumatic birth injury that affects an estimated 2-3 million women globally [1]. OF has broad physical and psychosocial ramifications, and women with OF are severely stigmatized and marginalized. Despite clinically successful surgery, physical disabilities and poor mental health may persist, making reintegration to family and community difficult for women. The post-surgical reintegration focus of my work is timely, as access to surgery has increased without parallel development of evidence-based reintegration programming. To address this gap, the training and research activities planned during the mentored phase of this award (K99) will build upon my capabilities to equip me with the necessary knowledge and skills in: 1) social-psychological health theories and methodologies; 2) mixed-methods research; 3) advanced quantitative methods for the analysis of longitudinal data; and 4) intervention development. Each of these activities will be instrumental to my successful advancement to the independent phase (R00) of this application, the aims of which are: 1) To conduct a systematic review of the published and grey literature on reintegration programming for OF and analogous conditions; 2) To design a post-surgical reintegration intervention for women and their households to improve women's psychosocial and physical recovery through iterative work with key stakeholders; and 3) To pilot the intervention developed in Aim 2 using a cohort- controlled design and measure the feasibility, acceptability and preliminary impact on post-surgical reintegration success. My mentorship and consulting team is uniquely poised to assist me in achieving my training and research goals, and ensure my transition to success as an independent investigator. This preparatory research, intervention development and pilot testing will lay the groundwork for an R01 which will expand this trial both in size and length of follow-up time in order to evaluate the effectiveness of the intervention on women's post-surgical reintegration, physical and mental disabilities, and economic status.
Obstetric fistula is a debilitating birth injury that affects an estimated 2 - 3 million women, most in sub-Saharan Africa. Over the past decade, fistula surgery has become more accessible; however, surgical success ranges from 60 - 90% and many women experience persistent fistula-related physical and mental health sequelae which impact their ability to reintegrate to their families and communities. This K99/R00 proposes training and research activities to develop expertise in obstetric fistula reintegration, followed y the development and pilot test of a multi-component reintegration intervention to improve women's psychosocial and physical recovery after fistula surgery.
