The following PRO instruments were administered preoperatively: Prolapse Quality of Life (P-QoL), Pelvic Organ Prolapse Symptom Score (POP-SS), Body Image in Pelvic Organ Prolapse (BIPOP), and Patient Health Questionnaire (PHQ-9). The P-QoL was used to evaluate women’s HRQoL. The P-QoL included 20-items divided into nine domains: general health perception (GHP), prolapse impact (PI), role (RL), physical (PL) and social limitation (SL), personal relationships (PR), emotional disturbances (EMO), sleep/energy disturbances (SE), and severity measures (SM). Each domain is related to a particular aspect of QoL, and scores in each domain range from 0 to 100. A higher score indicates poor QoL in each domain [13]. This study used a validated Amharic version of P-QoL [19]. The Amharic version had three components: physical (PC; including GHP, PI, PL, RL SL, and SM), psychological (PSC; including EMO and SE), and personal relationship (PRC; containing PR) [19]. The POP-SS was used to evaluate the severity of prolapse symptoms. POP-SS includes seven questions and scored from 0 to 28. Higher scores are indicative of more bothersome symptoms [14]. The present study used the Amharic version of POP-SS [20]. A woman’s perception of her body including genital body image and sense of attractiveness was evaluated using BIPOP. BIPOP includes 10-items, and each item uses a 5-point Likert response with lower scores indicating better body image [21]. The English version was translated into Amharic and then back into English to confirm correctness before use. We asked the patients to assess their depressive symptoms using the PHQ questionnaire. The questionnaire contains 9-items, with higher scores indicating more severe depressive symptoms. It has been validated for use in primary care and obstetrics/gynaecology outpatient clinics to diagnose major depressive disorders [22]. The current study utilised the Amharic version of PHQ [23]. We also evaluated patient’s postsurgical goals. Patients were asked to mention the three topmost goals for their planned surgery. The goals included were dropping prolapse, urinary or bowel symptoms, reducing pain, improving body image, activities and social life, intimate relationships, or general health or living happily. The list of goals were adapted from previous work [24].

At baseline, besides the abovementioned instruments, socio-demographic information (age, residence, marital, employment, and educational status), stage of POP and duration of POP symptoms (the number of years from the time POP symptoms first occurred, classified as delayed in need of healthcare if persisting more than a year) were collected using a standardised form. All baseline interviews were administered face-to-face at UoGH by trained female nurses.

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