Help-Seeking Behaviour and Associated Factors among Women with Urinary Incontinence in France, Germany, Spain and the United Kingdom
Introduction
Urinary incontinence (UI) is a common condition among women with as many as 25–40% of community dwelling adult women reporting having involuntary loss of urine with prevalence increasing with age [1], [2]. UI can affect the psychological well-being, perceived health and social life of the afflicted person [3], [4], [5]. The condition can be effectively treated with significant improvement of clinical and quality of life parameters [6].
Previous research has indicated that many women with UI do not consult a doctor about their condition [7], [8]. Reasons for not consulting a doctor include: seeing UI as a minor problem which can be self-managed [9], not regarding symptoms as abnormal or serious [10], [11], [12], hoping the condition improves by itself [13], regarding incontinence as a normal part of aging [14], being embarrassed to discuss it with a doctor [13], and lack of knowledge of possible treatments [10], [11], [13].
Previous research has shown that consultation rate increases with age, UI duration and frequency, and women's perception of ‘bothersomeness’ of the condition [7], [8]. In this study we explore whether other factors relating to UI, general health care, and women's attitudes are also associated with help-seeking behaviour for UI.
Most previous studies on help-seeking behaviour have been single country studies using different survey instruments that make it difficult to explore whether cultural or national differences exist between countries. This large cross-country study using the same survey instruments in France, Germany, Spain and the UK allows us for the first time to explore such cross-country comparisons.
In this paper we present the proportion of women who reported consulting a doctor due to UI in an initial survey and investigate possible factors associated with help-seeking behaviour in a follow-up study.
Section snippets
Methods
UI was defined as any leakage or involuntary loss of urine, conforming to the standards recommended by the ICS [15]. For the purpose of this study this definition was restricted to an incidence during the last 30 days.
Results
There was a response rate of 58% in the initial survey and 53% in the follow-up survey. Statistically significant differences were found in the characteristics of women responding to the initial and follow-up surveys (Table 1). Women with stress or mixed incontinence, who used pads and consulted a doctor about their UI, were more likely to respond to the follow-up survey showing some degree of selection bias. The difference in the consultation rate between the initial and follow-up surveys was
Discussion
In this study the same questionnaire and methodological approach were used in France, Germany, Spain and the UK and the responders were of a similar age. The samples included were representative of the general populations. The overall response rates of 58% and 53% to the initial and follow-up surveys respectively are not very high but acceptable. In France the response rate to the follow-up survey was only 33% and results from this country should therefore be interpreted with caution.
We could
Conclusions
Differences in help-seeking for UI exist between countries that cannot be fully explained by age, UI duration and frequency, and women's perception of the ‘bothersomeness’ of their UI. Women's health care behaviour and attitudes are also important and include whether women have spoken to others about their UI and women's general attitudes to long-term medication.
Acknowledgements
We would like to thank all women who participated in the postal surveys and thanks also to Dr Yngvild Hannestad for helpful comments on an earlier draft of this paper.
Sources of funding: Eli Lilly and Company and Boehringer Ingelheim funded the study. Eli Lilly and Company also employs S. Voss and D. Sykes. S. Hunskaar and G. Lose have received consultation fees, unrestricted research grants and funding for travel from Eli Lilly and Company, as well as other companies engaged in incontinence
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