TRIGGERS AND BARRIERS FORHELP-SEEKING BEHAVIOR AMONG WOMEN WITH URINARY INCONTINENCE: ACROSS-NATIONAL STUDY IN GERMANY AND DENMARK
L. SCHREIBER PEDERSEN1,G. LOSE 1, M. HOYBYE 2, M. JUERGENSEN 3,A. WALDMANN 4, M. RUDNICKI 5;
1HerlevGentofte Univ. Hosp., Herlev, Denmark, 2Institute forclinical medicine, Elective surgery center, Silkeborg Hosp.,Silkeborg, Denmark, 3Institute for the History of Medicineand Science Studies, Univ. of Luebeck, Luebeck, Germany, 4Institutefor Social Medicine and Epidemiology, Univ. of Luebeck, Luebeck,Germany, 5Dept. of Obstetrics and Gynecology, Odense,Denmark.
Introduction: Urinaryincontinence (UI) is a common condition with prevalence rates varyfrom 25-45% (1), depending on methodology, definition of UI and thepopulation included. A recent cross-national study including thepopulation in Germany and Denmark revealed prevalence rates at 48.3%and 46.4%, respectively (unpublished personal data). UI may have anegative impact on the affected women’s health related quality oflife and everyday living, depending on the severity of UI and thenature of the UI symptoms. Still only a minority of the affectedwomen seek professional help. Their decision on help-seeking may beinfluenced by multiple variables, including type of UI, severity,attitudes towards help-seeking, etc.
Objective: To evaluatehelp-seeking behavior among women aged 18+ years with UI in Denmarkand Germany’s united area Femern Belt Region.
Methods:The project was a mixed method cross-national survey conducted inDenmark and Germany in 2014. Eight thousand women aged 18+ years wererandomly selected, and received a postal questionnaire containingquestions concerning demographic and characteristics, ICIQ-UI SF,I-QOL and twelve new questions regarding help-seeking behavior. Thenew questions were developed and validated, initially by qualitativeexploring triggers and barriers among women with UI who either had orhad not sought help and through interdisciplinary expert rounds. Thequestions were cognitively tested and test-retested, with good tomoderate reliability. UI was defined as any involuntary loss ofurine, according to the IUGA/ICS 2002 terminology. Severity of UI wasbased on the ICIQ-UI SF score. To counteract for multiple testing,the level of significance was set to p<0.01.
Results:The response rates was significantly higher in Denmark (66.7%) thanin in Germany (46.2%) (p<0.001). Mean age of the participatingwomen were similar in both countries (GE 50.3 years, range 18-96; DK51.9 years, range 18-101). In Denmark 25.3% of women with UI “atleast sometimes” had consulted a physician compared to 31.4% inGermany (p=0.004). The consultation rate increased with the UIseverity, with the highest rate among women with severe UI (GE 76.9%;DK 69.3%). The subgroup of women with mixed UI (MUI) reported thehighest consultation rate (GE 41%; DK 31.7) compared to the subgroupsof women with UUI and SUI. Help-seeking women due to UI werecharacterized by being older, having a high frequency of leakage, alonger duration of symptoms and more severe UI. Furthermore, a higherproportion of these women had actively sought information regardingUI. In both countries, the majority of women waited no longer thanthree years after first occurrence of symptoms before seeking help.Significantly more help-seeking women stated, that they were willingto get an operation for their UI in both countries (p<0.001), andwere willing to take prescription drugs (in Denmark, p<0.001)compared to women who had not consulted a physician. Multivariateanalyses disclosed in the overall sample that severity , the factthat the woman had sought information regarding UI and duration of UIsymptoms, were significant predicting factors for help-seeking, withseverity being the strongest predictor (slight UI (reference);moderate UI OR 2.5, 95% CI 1.7-3.8; severe UI OR 6.6, 95% CI3.5-12.6; very severe UI OR 64.6, 95% CI 7.4-561.1). The same trendwas seen for each country, but in Germany “going to regularhealth-checks” was also a predicting factor, which was not the casein Denmark. The most common triggers for help-seeking for women withmoderate to very severe UI symptoms were impact on their social life,affection of their physical activities, because they were afraid thattheir UI would get worse and because their UI got worse. The mostcommon barriers for women with moderate to severe UI was lack ofmental resources for addressing the problem when speaking with theirphysician, because their other illnesses were more important, andbecause they did not see their UI as a problem.
Conclusions:The study demonstrates that only every third woman with UI in Germanyand every fourth woman with UI in Denmark has consulted a physicianregarding their UI symptoms. Severity of UI, and duration of UIsymptoms were significantly predicting factors for help-seeking, butalso whether the women had sought information regarding UI. Providingwomen with more information regarding UI and UI treatment options,may in time be able to interfere with women’s help-seekingbehavior.
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