Table 3 Barriers to fistula care index: sub-scale EFA and CFA factor loadings

Limited awareness

I did not know that fistula is a medical condition that can be treated

I believed that having fistula was a curse

I believed that my fistula was caused by diabolic means

I did not know where to go for fistula repair

Social abandonment

People who knew I had fistula avoided me

My husband/intimate partner treated me poorly initially

My husband/intimate partner treated me poorly later on

My husband/intimate partner abandoned me

I did not have someone to care for me and help me manage my condition at home

I did not have someone to support me in seeking and reaching care at the fistula center

Internalized stigma

I felt ashamed of having fistula

I felt worthless

I felt guilty because I had fistula

I felt I am not as complete as a person because I had fistula

Having fistula made me feel unclean

I felt embarrassed because of my condition

I felt isolated because of my fistula condition