ABSTRACT: Less than half of woman with urinary incontinence (UI) seek treatment. To explain the failure of women to seek treatment, a large number of factors have been examined that could influence their perceptions about UI. One such factor is race/ethnicity. Perceptions of women of different racial and ethnic groups about UI and seeking treatment are influenced by the level of their education, health-related knowledge, and resources. No prior systematic reviews have been conducted on perceptions and treatment-seeking behaviors in women of different racial/ethnic populations.
This systematic review compares perceptions about UI that affect treatment-seeking behavior in women in different racial and ethnic groups. Qualitative articles published between 1980 and 2011 that assessed perceptions of UI in women were obtained through a search of the following databases: MEDLINE, EMBASE, Scirus, Google Scholar, Open J-Gate, AgeLine, and Global Health (CABI). Selected articles were qualitative studies describing knowledge, perception, or personal views about UI in women. Excluded studies did not specify race/ethnicity, were performed exclusively in men, or reported non-UI urinary symptoms. Three independent reviewers screened all studies, selected pertinent studies, and abstracted data. The quality of studies was assessed by use of the relevance, appropriateness, transparency, and soundness (RATS) scale for qualitative research. Meta-analyses were not performed because of the use of qualitative data.
A total of 3676 citations were identified. Of these, 23 met all the inclusion criteria. Levels of quality among the 23 studies varied; 11 were high-quality, 2 were moderate-quality, and 10 were low-quality studies. Dominant themes across all studies fell into 2 major categories: UI management and UI experience. Women preferred discussing UI with another woman, even if she was not a physician. Nonwhite minority women expressed self-blame for incontinence symptoms and perceived UI as a negative consequence of prior sexual experiences or childbirth. Hispanic women maintained more secrecy about UI, even with close family members.
These data show similar UI management strategies and UI experiences across different racial/ethnic groups. Certain populations, however, have different perceptions about UI. These findings could be useful in planning future education strategies for women with incontinence.
Department of Obstetrics and Gynecology (N.Y.S.), Duke University Medical Center, Durham, NC; Department of Obstetrics and Gynecology (P.J.L.), University of Pennsylvania, Philadelphia, PA; and Department of Surgery (A.P., R.P.) and School of Nursing (N.A.), Duke University Medical Center, Durham, NC