title: Disease stigma and intentions to seek care for stress urinary incontinence among community-dwelling women.
abstract: OBJECTIVE
  Urinary incontinence (UI) threatens women's physical and mental health, but few women seek healthcare for their incontinence. Evidence is substantial that stigma may be associated with health service utilization for such diseases as mental illness, but sparse for UI. We examine the relationship between disease stigma and intentions to seek care for UI.
  
  
  METHODS
  A cross-sectional community-based study was used. A purposive sample of 305 women aged 40-65 years in a Chinese city who had stress urinary incontinence (SUI) was enrolled from May to October in 2011.
  
  
  METHODS
  Data were collected on socio-demographic characteristics, UI symptoms, disease stigma and intentions to seek care.
  
  
  RESULTS
  Social rejection was positively linearly related to intentions to seek care for UI (β=0.207; 95% CI=0.152, 0.784), indicating that more social rejection predicted stronger intentions to seek care. Significant curvilinear association between internalized shame and intentions to seek care was observed (β=-0.169; 95% CI=-0.433, -0.047). Compared to women with the low and high levels of internalized shame, those with the moderate level of internalized shame reported stronger intentions to seek care.
  
  
  CONCLUSIONS
  The impact of stigma on intentions to seek care varies by aspects and levels of stigma. Social rejection enhances intentions to seek care while internalized shame influences intentions to seek care in a quadratic way. The crucial step of targeted interventions will be to disentangle subgroups of SUI women with different aspects and levels of stigma.
authors.affiliation: School of Nursing, Shandong University, PO Box 141, 250012 Jinan, China. Electronic address: wangcuili@sdu.edu.cn.
authors.forename: Cuili
authors.initials: C
authors.lastname: Wang
authors.affiliation: School of Nursing, Shandong University, PO Box 141, 250012 Jinan, China. Electronic address: wanxiaojuan0406@163.com.
authors.forename: Xiaojuan
authors.initials: X
authors.lastname: Wan
authors.affiliation: School of Nursing, Shandong University, PO Box 141, 250012 Jinan, China. Electronic address: wangkf@sdu.edu.cn.
authors.forename: Kefang
authors.initials: K
authors.lastname: Wang
authors.affiliation: School of Nursing, Shandong University, PO Box 141, 250012 Jinan, China. Electronic address: yengcb@163.com.
authors.forename: Jingjing
authors.initials: J
authors.lastname: Li
authors.affiliation: Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing, China. Electronic address: 356464355@qq.com.
authors.forename: Tao
authors.initials: T
authors.lastname: Sun
authors.affiliation: Shandong Provincial Hospital, Jinan, China. Electronic address: 412964861@qq.com.
authors.forename: Xiaomeng
authors.initials: X
authors.lastname: Guan
mesh_terms: D000328:Adult; D000368:Aged; D002681:China; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008875:Middle Aged; D012044:Regression Analysis; D057545:Social Stigma; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D014550:Urinary Incontinence, Stress / Q000503:physiopathology / Q000523:psychology*
keywords: Disease stigma; Intentions to seek care; Stress urinary incontinence; Women