RESUMEN
Fertility experts have advocated addressing preventable causes of infertility and early intervention. However, awareness of risk factors is low, especially in low- and middle-income countries where the prevalence of infertility is high. To address this lack of awareness, the Fertility Awareness Tool (FertiSTAT) was adapted for use in Sudan and other low-resource countries. The aims of this study were to ascertain the need for fertility education in Sudan (Aim 1), and to gauge the acceptability and feasibility of implementing the FertiSTAT in Sudan (Aim 2), both from the patients' perspective. Convenience sampling was used to recruit participants for semi-structured-in-depth interviews from a fertility clinic in Sudan. We collected sociodemographic information, medical and reproductive history, asked about fertility knowledge, administered the FertiSTAT and asked about the acceptability of the FertiSTAT. Thematic analysis was conducted for qualitative data. Twenty participants were included; of these, 17 were female, 13 were educated beyond secondary school, the mean age was 32.8 years, and the mean duration of infertility was 4.1 years. Ten themes emerged: of these, three themes addressed Aim 1: 'desire for fertility information', 'state of fertility knowledge' and 'benefits of fertility education'; and seven themes addressed Aim 2: 'specific suggestions for the tool', 'factors influencing the acceptability and feasibility of implementing the tool', 'challenges and barriers to implementation', 'self-disclosure', 'understanding of being at risk', 'compatibility with worldview' and 'cultural tailoring'. Fertility education was viewed as necessary and beneficial; however, participants thought that lack of acceptability of sensitive topics would hinder the implementation of the FertiSTAT. Acceptability and feasibility would be enhanced if challenges were addressed in a culturally sensitive manner using cultural tailoring of materials to increase compatibility with individual worldviews.
RESUMEN
The World Health Organization (WHO) and World Bank have identified infertility as a global public health issue. Since the 1980s, WHO has advocated for a focus on prevention, especially where the burden of prevalence is highest, specifically in women from low- and middle-income countries (LMIC). The aim of the two studies presented here is to demonstrate a process to enhance implementation efforts in fertility awareness programmes that could assist in preventing some forms of infertility, and increase understanding of factors that could result in fertility problems. The fertility status awareness tool (FertiSTAT) for the Middle East was adapted to provide an illustrative example of requirements for region- or country-specific adaptation. The mixed methods approach used included a survey of international medical experts concerning the comprehensiveness of risks included in the original FertiSTAT (Study I), and stakeholder meetings to assess the feasibility and acceptability of using an adapted FertiSTAT in the Middle East (Study II). The results indicate that the content of the original FertiSTAT was acceptable but not comprehensive in its coverage of potential risk factors; for example, it did not include genital tuberculosis, human immunodeficiency virus, consanguineous relationships and female genital mutilation/cutting. Furthermore, stakeholder meetings revealed that implementation in the Middle East would be enhanced by the use of more culturally sensitive wording. The data highlight the importance of implementation research with participants from LMIC, and the need for standardized protocols for adaptation of any fertility awareness programme or tool before practical application.
