title: Effects of stigma on Chinese women's attitudes towards seeking treatment for urinary incontinence.
abstract: OBJECTIVE
  To examine whether and how stigma influences attitudes towards seeking treatment for urinary incontinence, and whether its effect varies by symptom severity.
  
  
  BACKGROUND
  Urinary incontinence is prevalent among women, but few seek treatment. Negative attitudes towards urinary incontinence treatment inhibit from seeking care. Urinary incontinence is a stigmatised attribute. However, the relationship between stigma and attitudes towards seeking treatment for urinary incontinence has not been well understood.
  
  
  METHODS
  This was a cross-sectional community-based study.
  
  
  METHODS
  We enrolled a sample of 305 women aged 40-65 years with stress urinary incontinence from three communities in a Chinese city between May-October in 2011. Data were collected on socio-demographic characteristics, urinary incontinence symptoms, stigma and attitudes towards seeking treatment for urinary incontinence using a self-reported questionnaire. Effects of stigma were analysed using path analysis.
  
  
  RESULTS
  Attitudes towards seeking treatment for urinary incontinence were generally negative. For the total sample, all the stigma domains of social rejection, social isolation and internalised shame had direct negative effects on treatment-seeking attitudes. The public stigma domain of social rejection also indirectly affected treatment-seeking attitudes through increasing social isolation, as well as through increasing social isolation and then internalised shame. The final model accounted for 28% of the variance of treatment-seeking attitudes. Symptom severity influenced the strength of paths: the effect of internalised shame was higher in women with more severe urinary incontinence.
  
  
  CONCLUSIONS
  Stigma enhances the formation of negative attitudes towards seeking treatment for urinary incontinence; public stigma affects treatment-seeking attitudes through internalisation of social messages.
  
  
  CONCLUSIONS
  Stigma reduction may help incontinent women to form positive treatment-seeking attitudes and engage them in treatment. Interventions should specifically target the self-stigma domains of social isolation and internalised shame in women with urinary incontinence to most efficiently increase their use of health care.
authors.affiliation: School of Nursing, Shandong University, Jinan, China.
authors.forename: Cuili
authors.initials: C
authors.lastname: Wang
authors.forename: Jingjing
authors.initials: J
authors.lastname: Li
authors.forename: Xiaojuan
authors.initials: X
authors.lastname: Wan
authors.forename: Xiaojuan
authors.initials: X
authors.lastname: Wang
authors.forename: Robert L
authors.initials: RL
authors.lastname: Kane
authors.forename: Kefang
authors.initials: K
authors.lastname: Wang
mesh_terms: D000328:Adult; D000368:Aged; D044466:Asian People / Q000523:psychology*; D002681:China; D003430:Cross-Sectional Studies; D005260:Female; D007722:Health Knowledge, Attitudes, Practice / Q000208:ethnology*; D006801:Humans; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000208:ethnology* / Q000523:psychology*; D015995:Prevalence; D012752:Shame; D057545:Social Stigma; D011795:Surveys and Questionnaires; D014549:Urinary Incontinence / Q000208:ethnology / Q000523:psychology / Q000628:therapy*
keywords: China; attitudes; stigma; treatment seeking; urinary incontinence; women