Communication for social change to reduce stigma of pelvic floor disorders in Amhara region, Ethiopia

Background to the research and interdisciplinary collaboration
The University of Leicester has established links with Gondar University, in the Amhara region of Ethiopia. Prof Tincello is leading an international collaborative, funded by a University of Leicester Tiger Team, to research pelvic floor dysfunction (PFD) among women in Amhara. The early phases of this research have revealed the need to engage in integrated and interdisciplinary ways to understand how communication can address underlying issues of stigma. At the same time, MCS’s reputation as a leader in research on communication for social change are growing, with a Public Communication research cluster, and new Masters Degrees on Communication for Social Change and Health Communication under development.

Research problem
PFD (urinary and faecal incontinence) is a common problem worldwide, estimated to affect 25% of women at some point during their lifetime. Risk factors include pregnancy, childbirth and ageing, with prolapse (abnormal protrusion of the bladder or rectum into the vagina), urinary and faecal incontinence the best recognised symptoms. Whilst much is known about the epidemiology, impact and treatment of PFD in the developed world, there is much less data on prevalence, impact or treatment in many of the poorer countries of the world, including Ethiopia. Prof Tincello and colleagues recently completed an initial fieldwork visit, and the provision of care for women with urinary incontinence (not related to fistula) or prolapse is very limited.

In preparation for a series of intervention studies led by Prof. Tincello, we learned that there is significant stigma in relation to urinary incontinence and prolapse, and that the issue is given low priority by health services. Women often conceal their symptoms for fear of social isolation, rejection and divorce and we identified a lack of education and knowledge about the causes of and availability of treatment for pelvic floor disorders, both among women and among their communities.

CfSC can be useful approach for addressing stigma. CfSC is a field of research and practice focusing on the use of communication as a means to facilitate enhanced knowledge, understanding, voice, dialogue, and participation with the aim of achieving positive social change. However, very often Health Communication focuses mainly or only on individual behaviour change. HIV/AIDS communication has highlighted the need to simultaneously address factors such as gender, class, policy, structures, and cultural contexts. However, little research is available on the application of holistic CfSC approaches to other sensitive health issues.

Research
This PhD research will explore women’s experiences, knowledge, and beliefs of pelvic floor disorders by means of qualitative interviews and workshops with women, their families, and key social contacts. We anticipate 20-25 semi-structured interviews would be conducted. Purposive sampling will be used to include women with a range of characteristics based on age, parity, place of residence and experience symptoms. The candidate will lead these interviews, supported by the supervisors and other colleagues within the Global Health Tiger Team.

The candidate will also study individual and community understandings and experiences of the conditions, including through the use of participatory techniques (such as participatory theatre, mapping, photovoice etc.), to explore the educational and voice needs of the women and their community groups, and work with them to co-create story-lines, key messages, media content and communication processes. This research will contribute to knowledge on health communication approaches that can address issues where stigma is a primary barrier to health access.