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Objective To assess the effect of initial visit with a specialist on disease understanding in women with pelvic floor disorders. Methods Women with referrals or chief complaints suggestive of urinary incontinence (UI) or pelvic organ prolapse (POP) were recruited from an academic urology clinic. Patients completed a Test of Functional Health Literacy in Adults (TOFHLA) and scripted interview sessions before and after the physician encounter. Physician treatment plans were standardized based on diagnosis and were explained using models. Interview transcripts were analyzed using qualitative grounded theory methodology. Results Twenty women with pelvic floor disorders (UI or POP) were recruited and enrolled in this pilot study. The mean age was 60.5 years (range 31–87 years) and the majority of women were Caucasian with a college degree or beyond. TOFHLA scores indicated adequate to high levels of health literacy. Preliminary themes before and after the physician encounter were extracted from interviews, and two main concepts emerged: 1) After the initial physician visit, knowledge of their diagnosis and the ability to treat their symptoms relieved patient concerns related to misunderstandings of the severity of their disease 2) Patients tended to focus on treatment and had difficulty grasping certain diagnostic terms. This resulted in good understanding of treatment plans despite an inconsistent understanding of diagnosis. Conclusion Our findings demonstrated a significant effect of the initial physician visit on patient understanding of her pelvic floor disorder. Despite the variation in diagnostic recall after the physician encounter, patients had good understanding of treatment plans. This served to increase perceived control and adequately relieve patient fears.

Objectives To assess the effect of the initial visit with a specialist on disease understanding among Spanish-speaking women with pelvic floor disorders. Methods Spanish-speaking women with referrals suggestive of urinary incontinence (UI) and/or pelvic organ prolapse (POP) were recruited from public urogynecology clinics. Patients participated in a health literacy assessment and interview before and after their physician encounter. All interviews were analyzed using Grounded Theory qualitative methods. Results Twenty-seven women with POP (N=6), UI (N=11), and POP/UI (N=10) were enrolled in this study. The mean age was 55.5 years and the majority of women had marginal levels of health literacy. From our qualitative analysis, three concepts emerged. First, was that patients had poor understanding of their diagnosis before and after the encounter regardless of how extensive the physician’s explanation or level of Spanish-proficiency. Secondly, patients were overwhelmed with the amount of information given to them. Lastly, patients ultimately put their trust in the physician, relying on them for treatment recommendations. Conclusions Our findings emphasize the difficulty Spanish-speaking women with low health literacy have in understanding information regarding pelvic floor disorders. In this specific population, the physician has a major role in influencing patients’ treatment decisions and helping them overcome fears they may have about their condition.

OBJECTIVES As the aging population in the United States grows, the investigation of urinary incontinence (UI) issues becomes increasingly important, especially among women. Using data from the California Health Interview Survey (CHIS), we sought to determine the prevalence and correlates of UI among an ethnically diverse population of older, community-dwelling women. METHODS 5,374 female Californians aged 65 or older participated in a population-based, cross-sectional random digit dialing telephone survey. The CHIS 2003 adult survey included one question for Californians aged 65+ about UI. Additional information collected via the self-reported survey included demographics (age, race/ethnicity, education, and household income); general health data (self-reported health status, height and weight, fall history, and special equipment needs); medical co-morbidities; and health behaviors (tobacco usage, physical activity, and hormone replacement therapy (HRT)). RESULTS The estimated state-wide female prevalence rate for UI was 24.4%. Prevalence rates increased with age. UI was significantly associated with poorer overall health (adjusted OR 3.43, p<0.001), decreased mobility (OR 1.81, p=0.004), current use of HRT (OR 1.72, p<0.001), being overweight or obese (OR 1.60, p<0.001), a history of falls (OR 1.53, p=0.002), and a history of heart disease (OR 1.38, p=0.010). After adjusting for all health factors, UI was not found to have any significant association with level of education, household poverty status, or smoking status. CONCLUSIONS UI prevalence among this diverse group of older community-dwelling Californian women parallels that of other population-based studies. CHIS demonstrated that poor health, increased BMI, falls, and decreased mobility are strongly correlated with UI.

Objectives To better understand women's experience with pelvic organ prolapse and to compare this experience between English and Spanish speaking women. Methods Women with pelvic organ prolapse were recruited from female urology and urogynecology clinics. Eight focus groups of 6-8 women each were assembled; four groups in English and four in Spanish. A trained bilingual moderator conducted the focus groups. Topics addressed patients' perceptions, their knowledge and experience with pelvic organ prolapse symptoms, diagnostic evaluation, physician interactions, and treatments. Results Both English and Spanish speaking women expressed the same preliminary themes: lack of knowledge regarding the prevalence of pelvic organ prolapse, feelings of shame regarding their condition, difficulty in talking with others, fear related to symptoms, and emotional stress from coping with pelvic organ prolapse. In addition, Spanish speaking women included fear related to surgery and communication concerns regarding the use of interpreters. Two overarching concepts emerged: first - a lack of knowledge which resulted in shame and fear; and second - public awareness regarding pelvic organ prolapse is needed. From the Spanish speaking an additional concept was the need to address language barriers and the use of interpreters. Conclusions Both English and Spanish speaking women felt ashamed of their pelvic organ prolapse and were uncomfortable speaking with anyone about it, including physicians. Educating women on the meaning of pelvic organ prolapse, symptoms, and available treatments may improve patients' ability to discuss their disorder and seek medical advice; for Spanish speaking women, access to translators for efficient communication is needed.