Date on Master's Thesis/Doctoral Dissertation

12-2005

Document Type

Doctoral Dissertation

Degree Name

Ph. D.

Department (Legacy)

Department of Epidemiology and Clinical Investigation Sciences

Committee Chair

Kelly, Susan E.

Author's Keywords

Ethnicity; Incontinence; Community-dwelling

Subject

Urinary incontinence; Ethnicity--Case studies

Abstract

Urinary incontinence is a major public health problem affecting 30% of community dwelling women aged 35-85. Urinary incontinence may have a significant impact on activities of daily living depending on the severity of symptoms. Women with urinary incontinence suffer from psychological distress associated with the self-imposed social isolation required to hide their disorder from friends and family. The annual health care costs for managing urinary incontinence has been estimated at nearly 26 million dollars and 70% of these costs are attributed to remedies that are not covered by healthcare insurance. Yet, only 25-50% of incontinence sufferers seek professional care for symptoms. The prevalence rate of urinary incontinence is similar for women from varying ethnic backgrounds. Yet health care disparities may exist amongst incontinent women from varying ethnic backgrounds for a number of reasons including access to care differences. Recently, one study identified ethnicity as an independent predictor of incontinence care seeking during bivariate analysis. However measures of symptom severity explained the association between ethnicity and incontinence care seeking during multivariate analysis. The purpose of this study was to determine if ethnicity was an independent predictor of incontinence care seeking using the Theory of Care Seeking Behavior to guide our research. Both Blacks and Hispanics were less likely to seek incontinence care than Whites, independent of socioeconomic status and measures of symptom severity. None of the measured psychosocial (affect, utility, norms and habits) and barrier variables from the Theory of Care Seeking Behavior explained the association between ethnicity and incontinence care seeking. The social construct of ethnicity includes bias, stereotyping, cultural competence, religiosity, spirituality, and lay illness which could explain the between ethnic group differences in incontinence care seeking identified in my study. Measurement of these variables, in conjunction with clinical and demographic, or psychosocial and barrier variables from the Theory of Care Seeking Behavior may explain the within ethnic group differences in incontinence care seeking, if they truly exist. Researchers should be able to develop modifiable predictor-specific interventions aimed at reducing health care disparities between ethnic groups by increasing the percentage of all incontinent women who seek care.

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