title: Measuring the barriers against seeking consultation for urinary incontinence among Middle Eastern women.
abstract: BACKGROUND
  Existing questionnaires to assess barriers against consultation for urinary incontinence (UI) are not appropriate for use in the Middle East culture. The aim of this study was to explore barriers against seeking help for UI and introducing a questionnaire that assess these barriers among those women. This is important before proceeding to any educational programs or having interval clinical audits to help incontinent women.
  
  
  METHODS
  1- Screening for UI. Women - aged 20 years and older, attending the outpatient Urology and Gynaecology clinics were invited to participate and interviewed by a research nurse. The UDI-6 was administered to assess the presence and type of UI. Women with UI as their chief complaint were excluded. 2- Interviewing study subjects for possible barriers. Subjects who had UI - as determined by the UDI-6-were first asked an open question "what prevented you from seeking medical consultation for urine leakage?"." They were then asked the proposed questions to assess possible barriers. We developed a preliminary questionnaire based on a review of reasons for not seeking incontinence care from the literature and the response of UI sufferers to the open question in this study. The questionnaire was modified many times to reach this final form. 3- Pilot Study to assess characteristics of the questionnaire. Validity and reliability of the final version of the questionnaire were assessed in a small pilot study including 36 women who completed questionnaire at initial visit and again after 2 weeks.
  
  
  RESULTS
  Of the 1231 subjects who agreed to participate in the study, 348 reported having UI. About 80% of incontinent women have never sought medical advice. Factors significantly associated with seeking help were husband encouragement, prayer affection and having severe UI. Common barriers were embarrassment and assuming UI as a normal part of aging. A pilot study included 36 women to assess the psychometric properties of the questionnaire after modifying it. The number of missing or not interpretable responses per item ranged from 2.2% to 8.7%. Internal consistency of the items was good. The test-retest reliability of individual items of the questionnaire was variable, with weighted kappa statistics ranging from 0.32 to 0.94 (median, 0.76, p 0.000).
  
  
  CONCLUSIONS
  Preliminary data on our proposed questionnaire show that it is an easy to administer, stable and suits the Middle Eastern culture.
authors.affiliation: Department of Urology, Section of Female Urology and Neurourology; Assiut University Hospital, Assiut University, Assiut, Egypt. elazab@hotmail.com
authors.forename: Ahmed S
authors.initials: AS
authors.lastname: El-Azab
authors.forename: Omar M
authors.initials: OM
authors.lastname: Shaaban
mesh_terms: D000328:Adult; D000554:Ambulatory Care Facilities; D001294:Attitude to Health / Q000208:ethnology*; D003144:Communication Barriers; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008875:Middle Aged; D008877:Middle East / Q000453:epidemiology; D017063:Outcome Assessment, Health Care; D010342:Patient Acceptance of Health Care / Q000208:ethnology*; D011594:Psychometrics; D012017:Referral and Consultation / Q000706:statistics & numerical data; D015203:Reproducibility of Results; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D014549:Urinary Incontinence / Q000175:diagnosis / Q000208:ethnology* / Q000628:therapy; D016387:Women's Health / Q000208:ethnology*; D055815:Young Adult