Help-seeking behavior among women currently leaking urine in Nigeria: is it any different from the rest of the world?

Prevalence and Influencing Factors of Help-Seeking Behavior Among Women with Urinary Incontinence: A Systematic Review and Meta-Analysis

Purpose: This systematic review and meta-analysis aimed to investigate the mean (weighted) prevalence of help-seeking behavior among women with urinary incontinence (UI) in relevant subgroups and the related influencing factors. Materials and Methods: Six English and four Chinese databases were systematically searched between 1996 and July 10, 2022. Two researchers independently screened the literature, extracted data, and evaluated the quality of the included studies. All statistical analyses were conducted using RevMan 5.4. Results: The mean (weighted) prevalence of help-seeking behavior based on the 41 included studies, including a total of 32,640 women with UI, was 28% (95% confidence interval [CI]: 22%-34%). We performed a subgroup analysis based on UI type, population, region, publication time, case definition of help-seeking, and use of validated tools to determine UI. The results of the subgroup analysis showed that the pooled prevalence of help-seeking behavior was 23% (95% CI: 14%-32%) among pregnant and maternity women, 27% (95% CI: 19%-35%) among menopausal women, 24% (95% CI: 14%-35%) among 20- to 50-year-old women, 31% (95% CI: 25%-36%) among those older than 50 years, 24% (95% CI: 17%-30%) in Asia, and 33% (95% CI: 22%-44%) in Europe. Meanwhile, the pooled odds ratio showed that education level, UI type, UI severity, and quality of life significantly influenced help-seeking behavior among women with UI. Conclusions: This systematic review revealed that the pooled prevalence of help-seeking behaviors among women with UI is 28%. These influencing factors have important implications for adapting to health care and social care systems.

Seeking consultation for urinary incontinence: Behaviours and barriers among Jordanian women

INTRODUCTION

The rates of seeking consultation for urinary incontinence (UI) and the barriers against consultations vary among countries and study populations and are influenced by various factors such as embarrassment, perception of illness, resources and culture.

OBJECTIVES

To study healthcare-seeking behaviours and barriers among Jordanian women.

METHODS

Between 1 March 2020 and 15 April 2020, we conducted a cross-sectional online survey among women 18 years of age or more who have UI and have access to the internet. We collected women's characteristics, UI types, severity, bother, seeking consultation behaviours and barriers. Logistic regression analyses were used to study the variables associated with seeking consultation.

RESULTS

The data of 1454 women with a mean age (SD) of 41.5 (11.5) years were analysed. Mixed UI was the most common type (56.3%), while 43.8% of the participants sought consultation, and 33.8% waited 1 year before seeking consultation. The most common barriers were embarrassment (52.2%), considering UI as a normal occurrence with ageing (41.5%), and limited expectations of improvement from treatment (42.0%). The most common barriers vary according to UI type. Embarrassment was the most commonly reported barrier by women with mixed UI (29.4%), UI as normal with ageing was mostly considered by women with stress UI (11.5%) and treatment for UI is going to be expensive was expressed by women with mixed UI (19.4%). Seeking consultation decreased among women with more educational achievement (adjusted odds ratio [aOR]: 0.62; 95% confidence interval [CI]: 0.44-0.87) with university graduates doing so less than women with high school or less educational achievement. Additionally, seeking consultation was more among women who were aware of a family member with UI (aOR: 1.44; 95% CI: 1.03-2.01) compared to women who were not. Also, multiparous women (aOR: 1.8; 95% CI: 1.19-2.77) sought consultation more than nulliparous women. Seeking a consultation was more among women who were bothered by the impact of UI on various daily activities, namely, household activities (aOR: 1.42; 95% CI: 0.85-2.37), prayers (aOR: 1.7; 95% CI: 1.07-2.71) and sex life (aOR: 2.48; 95% CI: 1.45-4.21) compared to women who were not bothered. Seeking a consultation was less among women who reported embarrassment as a barrier (aOR: 0.534; 95% CI: 0.34-0.84) compared to women who were not embarrassed.

CONCLUSION

Four in 10 women with UI sought care, but with a considerable delay between the onset of symptoms and actual care seeking. These outcomes could be explained by the impact of various barriers. Additionally, barriers might vary in different cultures and countries, so culture-sensitive questionnaires should be considered when healthcare-seeking consultations and barriers are studied.

Women's health seeking behavior for pelvic floor disorders and its associated factors in eastern Ethiopia

BACKGROUND

Pelvic floor disorders (PFDs), include urinary incontinence, overactive bladder, anal incontinence, and pelvic organ prolapse negatively affect physical, psychosocial, and economic wellbeing of women. In developing countries, less than a quarter of women with PFDs seek health care for their problem. Health care seeking for PFDs, and its associated factors, is little known in Ethiopia. This study aimed to assess health care seeking for PFDs, associated factors, and deterrents for seeking care.

METHODS

From a community based cross sectional study conducted form August 10 to September 4, 2016 to assess pelvic floor disorders, seven hundred four participants with PFDs drawn for health care seeking behavior analysis. Data were collected through interviewed administered questionnaire. Poisson regression model with robust variance was used to investigate the association of the independent variable with health care seeking behaviors. The results are reported in crude and adjusted prevalence ratio with 95% confidence intervals.

RESULT

Two hundred twenty five (32%; CI: 26.8-35.5) women sought care for their PFDs. Majority 160 (71%) of them seek care from government health facilities. Middle wealth index Adjusted Prevalence Ratio (APR) = 1.4, CI: 1.1, 1.8), autonomous decision making on own health (APR = 1.3, CI: 1.1, 1.7), and sever impact of PFDs on quality of life (APR = 1.4, CI:1.1, 1.9) were identified as associated factors for health care seeking.

CONCLUSION

A large number of women with pelvic floor disorder did not seek health care: this calls for urgent and tailored intervention to enhance health care seeking behaviors of women with PFD.

Poverty and health among CDC plantation labourers in Cameroon: Perceptions, challenges and coping strategies

Creating better access to good quality healthcare for the poor is a major challenge to development. In this study, we examined inter-linkages between poverty and disease, referred to as poverty-related diseases (PRDs), by investigating how Cameroon Development Corporation (CDC) camp dwellers respond to diseases that adversely affect their health and wellbeing. Living in plantation camps is associated with poverty, overcrowding, poor sanitation and the rapid spread of diseases. In a survey of 237 CDC camp dwellers in Cameroon, we used the health belief model to understand the drivers (perceived threats, benefits and cues for treatment seeking) of reported responses. Using logistic regression analysis, we looked for trends in people’s response to malaria. We calculated the odds ratio of factors shown to have an influence on people’s health, such as food, water, sanitation challenges and seeking formal healthcare for malaria. Malaria (40.3%), cholera (20.8%) and diarrhoea (17.7%) were the major PRDs perceived by camp dwellers. We found a strong link between what respondents perceived as PRDS and hygiene conditions. Poverty for our respondents was more about living in poor hygiene conditions than lack of money. Respondents perceived health challenges as stemming from their immediate living environment. Moreover, people employed self-medication and other informal health practices to seek healthcare. Interestingly, even though respondents reported using formal healthcare services as a general response to illness (84%), almost 90% stated that, in the case of malaria, they would use informal healthcare services. Our study recommends that efforts to curb the devastating effects of PRDs should have a strong focus on perceptions (i.e. include diseases that people living in conditions of poverty perceive as PRDs) and on hygiene practices, emphasising how they can be improved. By providing insights into the inter-linkages between poverty and disease, our study offers relevant guidance for potentially successful health promotion interventions.

Poverty is a condition that increases disease risks and presents severe health challenges. The negative impact of poverty on health is well understood, but much less is known about how people living in poor conditions themselves perceive health challenges and how they try to overcome these challenges. We studied a group of Cameroon Development Corporation (CDC) plantation workers, living in housing provided by the company, known as camps. Living conditions in plantation camps are characterised by small and very basic housing, shared toilet facilities and overall poor sanitation. In the camps, water sources were public taps found in strategic areas. During water cuts, camp dwellers used streams as their water sources. Water was treated at CDC management level. We questioned 237 labourers (or dependants) on matters related to their health. Malaria, cholera and diarrhoea were reported as the main diseases that they associated with poverty. Our results also show that the labourers associated poverty primarily with the poor state of their living conditions rather than with not having money. Even though CDC offered free healthcare, camp dwellers relied on self-treatment and unofficial medication, especially for malaria for which almost 90% of the workers did not use the free services. Therefore, for interventions to be successful, they should include people’s perceptions and focus on improving hygiene conditions.

Poverty-related diseases (PRDs): unravelling complexities in disease responses in Cameroon

BACKGROUND

In Cameroon, poverty-related diseases (PRDs) are a major public health concern. Research and policies addressing PRDs are based on a particular understanding of the interaction between poverty and disease, usually an association between poverty indicators and health indicators for a specific country or region. Such indicators are useful but fail to explain the nature of the linkages between poverty and disease or poverty and health. This paper presents results of a study among university students, unravelling how they perceive diseases, the linkages with poverty, their responses to diseases and the motivations behind reported responses. Based on the health belief model, this cross-sectional study was carried out among 272 students at the universities of Buea and Yaoundé in Cameroon. Data were collected using questionnaires containing items matching the research objectives. The questionnaires were self-completed.

RESULTS

Malaria was considered as the most common disease perceived and also a major PRD. Contrary to official rankings of HIV/AIDS and TB, cholera and diarrhoea were considered as other major PRDs. Also, typhoid fever was perceived to be more common and a PRD than HIV/AIDS and TB combined. The most prominently attributed cause for disease was (lack of) hygiene. In response, students deployed formal and/or informal healthcare strategies, depending on factors like available money, perceived severity of the disease and disease type. Discrepancies were observed in respondents' response to diseases generally and to malaria in particular. Even though, overall, respondents pre-dominantly reported a formal healthcare response toward diseases in general, for malaria, informal responses dominated. There was an overall strong awareness and (pro)activity among students for dealing with diseases.

CONCLUSIONS

Although the high use of informal facilities and medication for malaria may well be a reason why eradication is problematic, this seems to be a deliberate strategy linked to an awareness of the limitations of the formal health system. In any intervention intended to foster health, it is therefore vital to consider people's perceptions toward diseases and their response strategies. Our results give important leads to health promotion interventions to develop group-specific programs.

Barriers to urinary incontinence care seeking in White, Black, and Latina women

OBJECTIVE

We compared barriers to urinary incontinence (UI) healthcare seeking between white, black, and Latina women.

METHODS

This is a cross-sectional study using a convenience sample of white, black, and Latina women. Women completed the Barriers to Incontinence Care Seeking Questionnaire (BICS-Q), the Incontinence Quality of Life Instrument (I-QOL), the Questionnaire for Urinary Incontinence Diagnosis, and the Incontinence Severity Index (ISI). The primary objective was to assess barriers to UI care seeking among groups, as measured by the BICS-Q. Secondary objectives were to assess factors associated with barriers to incontinence care and to compare specific barriers using BICS-Q subscale scores. Regression analyses were used to further assess for differences among groups while adjusting for potential confounding variables.

RESULTS

We included a total of 93 subjects, including 30 white, 33 black, and 30 Latina women. Mean I-QOL, Questionnaire for Urinary Incontinence Diagnosis, and ISI scores were not significantly different among our 3 groups. Barriers, based on BICS-Q scores, were lowest in white women and higher in blacks and Latinas (2.9 vs 7.3 vs 10.9, respectively; P < 0.001). When adjusting for potential confounders such as age, income, education, presence of UI, ISI score, and I-QOL score, Latinas continued to demonstrate higher barriers compared with white or black women (β = 7.4; 95% CI, 2.2-12.7; P = 0.006). There were no significant differences between black women compared with other groups in the adjusted analyses.

CONCLUSIONS

Latinas experience more barriers to UI healthcare seeking compared with white and black women.

Adaptation and validation of the Michigan Incontinence Severity Index in a Turkish population

OBJECTIVE

To translate and validate the Michigan Incontinence Severity Index (M-ISI) for its use in Turkish-speaking women with urinary incontinence.

METHODS

The translation and cross-cultural adaptation were based on international guidelines. Content validity by content validity ratio/content validity index, internal consistency by Cronbach's alpha, test-retest reliability by Pearson's correlation, and construct validity by using Spearman rank correlations to show the relationship between individual items and the relevant domains and subdomains were analyzed in 100 female participants with a chief complaint of urinary incontinence. Correlations between the relevant scores of M-ISI and The International Consultation on Incontinence Questionnaire - Short Form scores were analyzed to indicate convergent validity. The Varimax rotation method was used to conduct exploratory factor analysis in order to investigate the factor structures/distribution of M-ISI items.

RESULTS

Content validity index and content validity ratio values increased to 0.97 and 1.00, respectively, showing sufficient content validity of the Turkish version of the M-ISI. The analysis formed three factors which was slightly different from original developers. In our proposed three-factor construct, all of the ten items demonstrated high correlations with their subdomains and lower correlations with the other domains, indicating good construct validity. Correlations between stress urinary incontinence and urge urinary incontinence (UUI) scores and The International Consultation on Incontinence Questionnaire - Short Form scores were found high, which indicated convergent validity (r: 0.953, P<0.001). Good internal consistency of the scores for each subdomain was observed (stress urinary incontinence, 0.787; UUI, 0.862; pad usage and bother, 0.832). Test-retest reliability was shown for each subdomain (stress urinary incontinence, 0.973; UUI, 0.973; pad usage and bother, 0.979).

CONCLUSION

The translated and cross-culturally adapted M-ISI showed good validity, reproducibility, and reliability that allow its use in Turkish-speaking populations with urinary incontinence. Its comprehensive structure means that it has become a practical instrument that is available for utilization in the primary health care setting, clinical research, and epidemiological trials in Turkey.

Factors associated with treatment-seeking behavior for postpartum urinary incontinence

PURPOSE

To identify the factors associated with treatment-seeking behavior for urinary incontinence (UI) among postpartum women.

DESIGN

This is a cross-sectional study. A total of 142 women with postpartum UI responded a telephone interview between August of 2010 and March of 2011. The association between the treatment-seeking and the predicting variables were measured through odds ratio and 95% confidence interval.

RESULTS

The treatment-seeking percentage was 37.3% and the treatment percentage was 27.5%. The result of multiple logistic regressions indicated that: counseling about UI in pregnancy, postpartum physical exercise, and Spanish nationality predicted 47.8% of the variance in treatment-seeking behavior

CONCLUSIONS

The lack of counseling largely determines the low rates of treatment-seeking among Spanish mothers.

CLINICAL RELEVANCE

Nursing counseling during pregnancy can contribute substantially to increasing the number of women treated for postpartum UI.