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      Assessing burden, risk factors, and perceived impact of uterine fibroids on women’s lives in rural Haiti: implications for advancing a health equity agenda, a mixed methods study

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          Abstract

          Background

          Uterine fibroids, the most common cause of gynecologic surgery, have a reported cumulative incidence of 59% among Black women in the U.S. Uterine fibroids negatively impact the quality of women’s lives. No study has been found in the literature about fibroids in Haiti. We conducted a mixed methods study to assess the burden and risk factors of uterine fibroids, as well as their effects on women’s quality of life.

          Methods

          A convergent mixed methods study was conducted between October 1, 2019 and January 31, 2020 at MUH’s (Mirebalais University Hospital) OB-GYN outpatient department. Quantitatively, in a cross-sectional study 211 women completed consecutively a structured questionnaire. In-depth interviews with 17 women with fibroids and 7 family members were implemented for the qualitative component. Descriptive statistics were calculated for clinical and social demographic variables. Logistic regression was performed to examine associations between fibroids and related risk factors. An inductive thematic process was used to analyze the qualitative data. A joint display technique was used to integrate the results.

          Results

          Of 193 women analyzed 116 had fibroids (60.1%). The mean age was 41.3. Anemia was the most frequent complication— 61 (52.6%). Compared to women without uterine fibroids, factors associated with uterine fibroids included income decline (AOR = 4.7, 95% CI: 2.1–10.9, p = < 0.001), excessive expenses for transport (AOR = 4.4, 95% CI: 1.6–12.4, p = 0.005), and family history with uterine fibroids (AOR = 4.6, 95% CI: 1.6–13.6, p = 0.005). In contrast, higher level of education and micro polycystic ovarian syndrome were associated with lower prevalence (AOR = 0.3, 95% CI: 0.1–0.9, p = 0.021) and (AOR = 0.2, 95% CI: 0.1–0.97, p = 0.044), respectively. The qualitative findings delineate how contextual factors such as health system failures, long wait times, gender inequality and poverty negatively affect the quality of women’s lives. The poverty cycle of uterine fibroids emerged.

          Conclusions

          A vicious cycle of poverty negatively impacts access to care for uterine fibroids in Haiti. Health insurance, social support, and income generating activities may be keys to promote social justice through access to adequate care for women with uterine fibroids in Haiti.

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          Most cited references36

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          Three approaches to qualitative content analysis.

          Content analysis is a widely used qualitative research technique. Rather than being a single method, current applications of content analysis show three distinct approaches: conventional, directed, or summative. All three approaches are used to interpret meaning from the content of text data and, hence, adhere to the naturalistic paradigm. The major differences among the approaches are coding schemes, origins of codes, and threats to trustworthiness. In conventional content analysis, coding categories are derived directly from the text data. With a directed approach, analysis starts with a theory or relevant research findings as guidance for initial codes. A summative content analysis involves counting and comparisons, usually of keywords or content, followed by the interpretation of the underlying context. The authors delineate analytic procedures specific to each approach and techniques addressing trustworthiness with hypothetical examples drawn from the area of end-of-life care.
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            Purposeful Sampling for Qualitative Data Collection and Analysis in Mixed Method Implementation Research.

            Purposeful sampling is widely used in qualitative research for the identification and selection of information-rich cases related to the phenomenon of interest. Although there are several different purposeful sampling strategies, criterion sampling appears to be used most commonly in implementation research. However, combining sampling strategies may be more appropriate to the aims of implementation research and more consistent with recent developments in quantitative methods. This paper reviews the principles and practice of purposeful sampling in implementation research, summarizes types and categories of purposeful sampling strategies and provides a set of recommendations for use of single strategy or multistage strategy designs, particularly for state implementation research.
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              Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development.

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                Author and article information

                Contributors
                milchristophe@gmail.com
                amanzi@pih.org
                arlene_katz@hms.harvard.edu
                Hannah_Gilbert@hms.harvard.edu
                mary_smith-fawzi@hms.harvard.edu
                paul_farmer@hms.harvard.edu
                Joia_Mukherjee@hms.harvard.edu
                Journal
                Int J Equity Health
                Int J Equity Health
                International Journal for Equity in Health
                BioMed Central (London )
                1475-9276
                1 January 2021
                1 January 2021
                2021
                : 20
                : 1
                Affiliations
                [1 ]GRID grid.417182.9, ISNI 0000 0004 5899 4861, Partners In Health, ; Boston, MA USA
                [2 ]Zanmi Lasante, Mirebalais University Hospital (MUH), Route Chatulee, Mirebalais, HT5211 Haïti
                [3 ]GRID grid.38142.3c, ISNI 000000041936754X, Department of Global Health and Social Medicine, , Harvard Medical School, ; Boston, MA USA
                [4 ]GRID grid.62560.37, ISNI 0000 0004 0378 8294, Division of Global Health Equity, , Brigham and Women’s Hospital, ; Boston, MA USA
                Author information
                http://orcid.org/0000-0001-8590-812X
                Article
                1327
                10.1186/s12939-020-01327-9
                7777531
                33386078
                b86ca2be-e1f7-46b1-99c1-7eaf201e027d
                © The Author(s) 2021

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                : 22 June 2020
                : 18 November 2020
                Funding
                Funded by: Harvard Medical School
                Award ID: Not applicable
                Categories
                Research
                Custom metadata
                © The Author(s) 2021

                Health & Social care
                uterine fibroids,risk factors,women,poverty,haiti
                Health & Social care
                uterine fibroids, risk factors, women, poverty, haiti

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