A reliable, valid instrument to assess patient knowledge about urinary incontinence and pelvic organ prolapse

Psychometric properties and feasibility of three scales assessing the level of knowledge and awareness about pelvic floor health

OBJECTIVE

Despite high prevalence and burden of pelvic floor dysfunctions (PFD), there is a limited number of scales assessing knowledge of pelvic floor health (PFH), and no studies comparing their psychometric or feasibility properties. The study aimed both to investigate the psychometric properties and feasibility of Incontinence Quiz (IQ), Prolapse and Incontinence Knowledge Questionnaire (PIKQ) and Pelvic Floor Health Knowledge Questionnaire (PFHKQ), and to compare level of PFH knowledge in women with and without PFD.

STUDY DESIGN

In this prospective cross-sectional study, a total of 150 women were included. After recording physical-sociodemographic characteristics, obstetric histories and menstrual status, Pelvic Floor Distress Inventory-20 and Female Sexual Function Index were administered to classify them into study groups as women with and without PFD. Their PFH knowledge was assessed using IQ, PIKQ and PFHKQ, which were filled twice with one week interval for the test-retest purpose. The scores, reliability, validity, ceiling-floor effects and feasibility of the knowledge scales were compared with each other, and between the study groups.

RESULTS

IQ, PIKQ, and PFHKQ scores of women with and without PFD were similar. Based on response patterns to items, PFHKQ had the highest internal consistency followed by PIKQ and IQ. The PIKQ was the most stable scale across the total sample and in the PFD group. The PFHKQ had the highest ICC value in women without PFD. There was a strong correlation between the total scores of knowledge scales in both groups. Scores of knowledge and symptom scales were not significantly correlated. IQ was completed in the shortest time, and was easier to complete than PFHKQ. Only the diagnosis/treatment subscale of PFHKQ had a ceiling effect.

CONCLUSION

It was concluded that PFH knowledge of women with and without PFD were at a low-moderate level and similar to each other; IQ, PIKQ and PFHKQ were reliable, valid and feasible scales, which can be used in measuring knowledge level about PFH.

Urinary Incontinence Care-Seeking Barriers Among Latina Patients: What Are We Missing?

IMPORTANCE

The Latina population is the largest growing ethnic group in the United States with high levels of health disparities in urinary incontinence (UI) treatment and complications rates, which may be due to disproportionately high barriers to UI care-seeking among Latinas.

OBJECTIVES

The objectives of this study were to compare barriers to UI care-seeking among Latina, non-Latina Black, and non-Latina White patients by utilizing the Barriers to Incontinence Care Seeking Questionnaire (BICS-Q) total scores, and to compare specific barriers utilizing BICS-Q subscales.

STUDY DESIGN

In this cross-sectional study, patients accessing primary care were recruited to complete the BICS-Q, International Consultation on Incontinence Questionnaire-Short Form, and Prolapse and Incontinence Knowledge Questionnaire-Urinary Incontinence. The BICS-Q total and subscale scores were compared among ethnic/racial groups.

RESULTS

A total of 298 patients were included in the study with 83 Black, 144 Latina, and 71 White participants per self-identified ethnicity/race. The total BICS-Q score was highest for Latina participants, followed by White and Black participants (11.2 vs 8.2 vs 4.9, respectively, P < 0.0001). Latina participants had significantly higher BICS-Q subscale scores compared with Black participants with no significant differences between Latina and White participants. After controlling for potential confounders, Latina ethnicity/race was still associated with a higher BICS-Q score when compared to Black ethnicity/race (P = 0.0077), and lower Prolapse and Incontinence Knowledge Questionnaire-Urinary Incontinence scores remained independently associated with higher BICS-Q scores (P = 0.0078).

CONCLUSIONS

In our study population, Latina patients and patients with lower UI knowledge experience higher barriers to UI care-seeking compared with Black patients and patients with higher UI knowledge. Addressing these barriers may increase care-seeking and improve health equity in the field.

Validation of the Arabic Linguistic Version of the Prolapse and Incontinence Knowledge Questionnaire

INTRODUCTION AND HYPOTHESIS

Pelvic floor disorders (PFDs), significantly impacting women's quality of life, are often underdiscussed owing to misconceptions and limited understanding of treatment options. This study is aimed at validating an Arabic version of the Prolapse and Incontinence Knowledge Questionnaire (PIKQ) to assess knowledge of pelvic organ prolapse (POP) and urinary incontinence (UI) among Arabic-speaking women, addressing knowledge gaps in these areas.

METHODS

The study obtained ethical approval and followed a two-stage process, including a pilot study for preliminary validation and a larger study involving 300 participants. The PIKQ, a self-administered tool with two scales focusing on UI and POP, was translated into Arabic with cultural and linguistic adaptations. The study evaluated the reliability and validity of the Arabic PIKQ, employing Cronbach's alpha, intraclass correlation coefficient (ICC), and Spearman's rho for reliability assessments, as well as factor analysis for construct validity.

RESULTS

The Arabic PIKQ demonstrated high internal consistency (Cronbach's alpha > 0.8) and test-retest reliability (ICC > 0.79) for both the UI and the POP scales. The questionnaire also showed significant construct validity. Among the 300 participants, knowledge gaps were evident, influenced by educational and professional backgrounds. Notably, 22% reported UI and 14.7% reported pelvic organ prolapse, with less than half seeking treatment.

CONCLUSIONS

The Arabic PIKQ has been validated as a reliable tool for improving knowledge and addressing misconceptions regarding PFDs among Arabic-speaking women. The study underscores the importance of culturally sensitive educational tools in enhancing awareness and facilitating access to medical care for pelvic floor disorders.

Validation of the Hungarian version of the Prolapse and Incontinence Knowledge Questionnaire (PIKQ)

Objective

The Prolapse and Incontinence Knowledge Questionnaire (PIKQ) is a self-administered, reliable and valid instrument which assess knowledge regarding urinary incontinence and pelvic organ prolapse. There is no validated Hungarian version of this questionnaire; therefore the aim of this study was to develop a reliable, valid and culturally sensitive Hungarian version of the PIKQ.

Study design

A cross-sectional study was conducted from March to October 2022 with a sample of 459 women. The PIKQ, which consists of the urinary incontinence and pelvic organ prolapse scales, was translated into Hungarian in accordance with international guidelines. The validity and reliability of the final version of the Hungarian PIKQ was evaluated using construct validity, comparison with known-groups, internal consistency and test-retest reliability.

Results

Regarding construct validity, all fit indices were found acceptable. Healthcare workers had significantly higher knowledge about urinary incontinence and pelvic organ prolapse (p < 0.001) compared to women who had not worked in a medical field. The Hungarian PIKQ had an adequate internal consistency with Cronbach alpha of 0.785 for the urinary incontinence scale and 0.826 for the pelvic organ prolapse scale. The correlation coeffcients between the test and retest was 0.931 for the urinary incontinence scale and 0.964 for the pelvic organ prolapse scale.

Conclusion

The Hungarian version of the PIKQ is a reliable and valid tool to measure the level of knowledge about urinary incontinence and pelvic organ prolapse among Hungarian speaking women.

Awareness of urinary incontinence in pregnant women as a neglected issue: a cross-sectional study

Background

Pregnancy and labor are independent risk factors for the development of urinary incontinence (UI). Although UI is common during pregnancy, it is a health problem mostly neglected by pregnant women. The high prevalence of UI in pregnancy and its effects on the postpartum period justifies the need to determine the knowledge and attitudes of pregnant women regarding the prevention and management of UI. It is necessary to increase the awareness of pregnant women about UI, educate, consultant, and integrate pelvic floor muscle training into prenatal care services. This study aims to determine the UI awareness of pregnant women and their knowledge and attitudes in this context.

Methods

This cross-sectional study was conducted with 255 pregnant women in a university hospital in Turkey between March and September 2020. Data were collected using the Incontinence Knowledge Questionnaire (PIKQ) and Urinary Incontinence Attitude Scale (UIAS).

Results

The UI prevalence was 51% during pregnancy. The mean score of PIKQ was 8.07±2.64, and only 6.3% of participants correctly answered all the questions regarding UI. The mean score of UIAS was 42.33±3.48. A positive correlation was found between UI knowledge and attitude score (r=0.35, p=0.00).

Conclusions

The results showed that although UI is prevalent during pregnancy, pregnant women's knowledge of UI is poor. Nearly half of pregnant women need information. They tend to display positive attitudes towards UI, but not sufficient to improve their health-seeking behavior. Strategies should be developed to increase pregnant women's awareness of UI and to encourage them health-seeking behaviors for the prevention/management of UI during prenatal visits.

Exploratory mixed methods study on care-seeking behaviors of Asian Americans with pelvic floor symptoms

INTRODUCTION AND HYPOTHESIS

The objective was to evaluate whether younger age was associated with noncare-seeking behavior among Asian Americans with pelvic floor symptoms, and secondarily, to explore multilevel factors that may contribute to noncare-seeking behavior in this population.

METHODS

We performed a concurrent mixed methods study and heterogeneously sampled Asian Americans with urinary incontinence, urgency-frequency, vaginal bulge, or anal incontinence. We stratified the participants into two groups, care seekers vs noncare seekers. Using Anderson's model as the main framework, we administered validated questionnaires and conducted semi-structured interviews to explore factors associated with care-seeking behaviors.

RESULTS

Seventy-eight surveys and 20 interviews were completed and analyzed. Most participants reported urinary leakage (67%), followed by urinary urgency-frequency (50%), anal incontinence (18%), and vaginal bulge (17%). The mean age of the study cohort was 46.1 ± 16.2 years. We found noncare seekers to be younger and with an increased proportion of lifetime spent in the USA than care seekers. When controlling for age, proportion of lifetime spent in the USA, symptom severity, and individual-level resources, both younger age and increased proportion of lifetime spent in USA remained independently associated with noncare-seeking behavior. From qualitative data, we found that noncare seekers often experienced anti-Asian racism across workplace, neighborhoods, and health care settings. Additionally, noncare seekers also reported symptom minimization and decreased self-efficacy when coping with their pelvic floor symptoms.

CONCLUSIONS

We found that one's age and proportion of lifetime spent in the USA may affect the extent of exposure to anti-Asian racism that is associated with symptom minimization, increased perceived barrier, and noncare-seeking behavior.

Educating Women About Pelvic Floor Disorders During Pregnancy From the First to the "Fourth Trimester": A Randomized Clinical Trial

IMPORTANCE

Pregnancy and childbirth are risk factors for developing pelvic floor disorders (PFDs), and this continues postpartum ("fourth trimester"). Knowledge of PFDs among women of childbearing age is lacking and presents an opportunity for education.

OBJECTIVES

The aim of this study was to compare the increase in knowledge of PFDs in patients who received written handouts versus interactive workshops as measured by the Prolapse and Incontinence Knowledge Questionnaire (PIKQ).

STUDY DESIGN

This was a randomized clinical trial of pregnant patients 18 years or older. Patients either received written handouts only or received handouts and attended an interactive workshop. Handouts were created in collaboration with communication specialists focusing on risk factors and prevention strategies. The primary outcome was the change in PIKQ score. Secondary outcomes were Pelvic Floor Distress Inventory score and postpartum phone interviews of workshop group participants. Questionnaires were assessed at recruitment and 6 weeks postpartum. The nonparametric Wilcoxon test compared continuous variables, and the Fisher exact test compared categorical variables.

RESULTS

One hundred twenty patients were randomized. Demographics were similar between groups. Median PIKQ score change showed no difference between groups (P = 0.37). Pelvic Floor Distress Inventory-20 scores were similar between groups at baseline (P = 0.78) and postpartum (P = 0.82). Quantile regression showed posteducation PIKQ scores were significantly higher in the workshop (21.00 vs 17.00; P = 0.011) and written (21.00 vs 17.00; P < 0.001) groups. Phone interviews showed consistent themes: (1) greater awareness of PFDs, (2) more likely to discuss PFDs, and (3) relief that PFDs are treatable. Fifty-nine percent of patients preferred learning through workshops compared with the handouts.

CONCLUSIONS

Both groups showed improvement in knowledge of PFDs. Well-written, illustrated handouts were effective in increasing patient knowledge of PFDs.

Knowledge of Pelvic Floor Dysfunction in African American and Afro-Caribbean Women Seeking Medical Care in a Primary Care Ambulatory Setting

IMPORTANCE

Approximately one fourth of U.S. community-dwelling women will develop a pelvic floor dysfunction (PFD) within their lifetimes. Prior research has revealed that knowledge of PFD was low to moderate in the general population and lower among Black patients.

OBJECTIVE

This study aimed to assess the proficiency of urinary incontinence and pelvic organ prolapse (POP) in self-identified African American and Afro-Caribbean adult (age ≥ 18 years) female patients seeking medical care in our ambulatory setting.

STUDY DESIGN

In this cross-sectional study, we administered the Prolapse and Incontinence Knowledge Questionnaire to patients in primary care and gynecology ambulatory settings at an academic medical center in Central Brooklyn. We used a multivariable Poisson regression model to find characteristics of the participants that are associated with proficiency in Prolapse and Incontinence Knowledge Questionnaire domains.

RESULTS

A total of 266 survey participants self-identified as African American or Afro-Caribbean. Overall, using a multivariable model, knowledge of POP was significantly higher among African Americans than Afro-Caribbeans, and 75.5% of our patients reported that they would seek information on urinary incontinence and POP from a medical provider (gynecologist or primary care doctor) compared with other alternatives (eg, internet, 19.6%).

CONCLUSIONS

These findings highlight subgroups that could benefit from provider-initiated education regarding PFD. Furthermore, although Black patients are often homogenized in research studies, differences may exist within subgroups likely because of varying interplays of structural racism and other social determinants of health, which may serve as an area of future research.

Pelvic floor disorder assessment of knowledge and symptoms: an educational intervention for Spanish-speaking women (PAKS study)

INTRODUCTION AND HYPOTHESIS

Educational interventions have been effective in improving postpartum knowledge, performance of pelvic floor exercises, and bowel-specific quality-of-life. Our primary objective was to determine if a video-based educational intervention on pelvic floor disorders (PFDs) would increase Spanish-speaking women's knowledge of PFDs, and secondarily to assess if it would decrease pelvic floor symptoms. We hypothesized that Spanish-speaking women would improve their pelvic floor knowledge and symptoms post-intervention.

METHODS

Inclusion criteria included women age 18 years and older and self-reported as a predominantly Spanish-speaker or equally bilingual English- and Spanish-speaker. Changes in knowledge were assessed with the Prolapse and Incontinence Knowledge Questionnaire (PIKQ). Changes in symptoms were assessed with the Pelvic Floor Distress Inventory-20 (PFDI-20). Linear regression assessed for independent effects.

RESULTS

One hundred and fourteen women were enrolled and 112 completed the pre- and post-intervention PIKQ. Mean (standard deviation [SD]) age was 50 (14) years. Immediate post-intervention scores showed significant improvement in knowledge. Total PIKQ score improved by 5.1 (4.7) points (p < 0.001). POP subscore improved by 2.7 (2.7) points (p<0.001) and UI subscore improved by 2.3 (2.5) points (p < 0.001). Improvement in knowledge continued after four weeks (p < 0.001). PFDI-20 prolapse (p=0.02), colorectal-anal (p < 0.001) and urinary (p = 0.01) scores significantly improved only for the most symptomatic women at baseline. Using linear regression, total PIKQ (p = 0.03) and total PFDI-20 scores (p = 0.04) were associated with predominantly Spanish-speakers versus fully bilingual.

CONCLUSION

Findings support the efficacy of a video-based educational intervention to improve knowledge of PFDs in Spanish-speaking women. The most symptomatic women benefitted from this intervention.

Condition-specific validation of the Arabic version of the Prolapse and Incontinence Knowledge Questionnaire (PIKQ) among parturient

INTRODUCTION AND HYPOTHESIS

Pregnancy and mode of delivery have a major effect on pelvic floor disorders (PFD). Assessing knowledge regarding PFD is essential not only for making more informed decisions regarding mode of delivery, but also for seeking help when PFD appear. The Prolapse and Incontinence Knowledge Questionnaire (PIKQ) is a validated tool that assesses women's knowledge regarding urinary incontinence (UI) and pelvic organ prolapse (POP). Validation of the Arabic version of the PIKQ had never been carried out. The purpose of this study was to conduct a condition specific validation among parturients of the PIKQ in the Arabic language.

METHODS

Translation of the PIKQ to the Arabic language was carried out according to international recommended guidelines. A cross-sectional study of pregnant women was conducted from June to September 2020 at the Soroka University Medical Center, Israel. The recommended 10:1 ratio between the number of subjects and the number of items in the questionnaire (n=24) was maintained. A total of 244 third trimester pregnant women have completed the Arabic version of the PIKQ. In addition to the validation of the psychometric characteristics, construct validity, criterion validity, and reliability were tested as well.

RESULTS

Initially, exploratory factor analysis (EFA) was conducted, resulting in two 12-item scales representing UI and POP. Then, to validate the scale construct we conducted confirmatory factor analysis (CFA). Results of the CFA demonstrated that the PIKQ displayed construct validity, with standardized factor loadings ranging from 0.30 to 0.62. Finally, Cronbach's alpha indicated a good internal reliability for the two factors UI and POP. Criterion validity further supported the validity of the scale.

CONCLUSIONS

The Arabic version of the PIKQ is a new, reliable, consistent, and valid instrument to examine the level of knowledge regarding UI and POP in Arabic speaking pregnant women. This instrument may be used to assess women's knowledge about PFD and to direct the need for educational interventions that may empower women to make informed decisions regarding perinatal care.

Development of a tool to assess bladder health knowledge, attitudes, and beliefs (BH-KAB)

INTRODUCTION

Few instruments measure knowledge, attitudes, and beliefs (KAB) related to bladder health. Existing questionnaires have predominantly focused on KAB related to specific conditions such as urinary incontinence, overactive bladder, and other pelvic floor disorders. To address this literature gap, the Prevention of Lower Urinary Tract Symptoms (PLUS) research consortium developed an instrument that is being administered in the baseline assessment of the PLUS RISE FOR HEALTH longitudinal study.

METHODS

The bladder health knowledge, attitudes, and beliefs (BH-KAB) instrument development process consisted of two phases, item development and evaluation. Item development was guided by a conceptual framework, review of existing KAB instruments, and a review of qualitative data from the PLUS consortium Study of Habits, Attitudes, Realities, and Experiences (SHARE). Evaluation comprised three methods to assess content validity and reduce and refine items: q-sort, e-panel survey, and cognitive interviews.

RESULTS

The final 18-item BH-KAB instrument assesses self-reported bladder knowledge; perceptions of bladder function, anatomy, and related medical conditions; attitudes toward different patterns of fluid intake, voiding, and nocturia; the potential to prevent or treat urinary tract infections and incontinence; and the impact of pregnancy and pelvic muscle exercises on bladder health.

CONCLUSION

The PLUS BH-KAB instrument may be used independently or in conjunction with other KAB instruments for a more comprehensive assessment of women's KAB related to bladder health. The BH-KAB instrument can inform clinical conversations, health education programming, and research examining potential determinants of bladder health, LUTS, and related behavioral habits (e.g., toileting, fluid intake, pelvic muscle exercises).

Patient-Reported Outcome Measures for Use in Women With Pelvic Organ Prolapse: A Systematic Review

OBJECTIVE

To describe the psychometric properties of existing patient-reported outcome measures for women with prolapse using the COSMIN (Consensus-Based Standards for the Selection of Health Measurement Instruments) framework. Additional objectives were to describe the patient-reported outcome scoring method or interpretation, methods of administration, and to compile a list of the non-English languages in which the patient-reported outcomes are reportedly validated.

DATA SOURCES

PubMed and EMBASE was searched through September 2021. Study characteristics, patient-reported outcome details, and psychometric testing data were extracted. Methodologic quality was assessed with COSMIN guidelines.

METHODS OF STUDY SELECTION

Studies reporting the validation of a patient-reported outcome in women with prolapse (or women with pelvic floor disorders that included a prolapse assessment) and reporting psychometric testing data on English-language patient-reported outcome for at least one measurement property per COSMIN and the U.S. Department of Health and Human Services definitions were included, as well as studies reporting the translation of an existing patient-reported outcome into another language, a new method of patient-reported outcome administration, or a scoring interpretation. Studies reporting only pretreatment and posttreatment scores, only content or face validity, or only findings for nonprolapse domains of the patient-reported outcome were excluded.

TABULATION, INTEGRATION, AND RESULTS

Fifty-four studies covering 32 patient-reported outcomes were included; 106 studies assessing translation into a non-English language were excluded from the formal review. The number of validation studies per patient-reported outcome (one version of one questionnaire) ranged from 1 to 11. Reliability was the most reported measurement property, and most measurement properties received an average rating of sufficient. The condition-specific patient-reported outcomes had on average more studies and reported data across more measurement properties compared with adapted and generic patient-reported outcomes.

CONCLUSION

Although measurement property data vary on patient-reported outcomes for women with prolapse, most data were of good quality. Overall, condition-specific patient-reported outcomes had more studies and reported data across more measurement properties.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO, CRD42021278796.

Hungarian Women's Health Care Seeking Behavior and Knowledge of Urinary Incontinence and Pelvic Organ Prolapse: A Cross-sectional Study

IMPORTANCE

Adequate knowledge about pelvic floor disorders could lead to increased health care-seeking behavior, improved symptoms, and quality of life.

OBJECTIVES

The aims of the present study were to evaluate Hungarian women's knowledge about pelvic floor disorders and to assess health care-seeking behavior.

STUDY DESIGN

We conducted a cross-sectional survey from March to October 2022 using self-administered questionnaires. The Prolapse and Incontinence Knowledge Questionnaire was used to assess Hungarian women's knowledge about pelvic floor disorders. The International Consultation of Incontinence Questionnaire-Short Form was used to gather information about the symptoms of urinary incontinence.

RESULTS

Five hundred ninety-six women were included in the study. Urinary incontinence knowledge was deemed proficient in 27.7% of participants, while pelvic organ prolapse knowledge was deemed proficient in 40.4% of participants. Greater urinary incontinence knowledge was significantly associated (P < 0.001) with higher level of education (P = 0.016), work in a medical field (P < 0.001), and ever practiced pelvic floor muscle training (P < 0.001), whereas greater pelvic organ prolapse knowledge was significantly associated (P < 0.001) with higher level of education (P = 0.032), work in a medical field (P < 0.001), ever practiced pelvic floor muscle training (P = 0.017), and ever had pelvic organ prolapse (P = 0.022). Of the 248 participants who reported a history of urinary incontinence, only 42 (16.93%) women sought care. Care seeking was higher among women who were more knowledgeable about urinary incontinence and among women with more severe symptoms.

CONCLUSIONS

Hungarian women had limited knowledge about urinary incontinence and pelvic organ prolapse. Health care seeking among women with urinary incontinence was low.

Pelvic Floor Disorders and Pelvic Floor Muscle Exercise: A Survey on Knowledge, Attitude, and Practice among Pregnant Women in Northwest Ethiopia

The purpose of the study was to investigate 1: overall knowledge of pelvic organ prolapse (POP) and urinary incontinence (UI) as well as knowledge, attitudes, and practice of pelvic floor muscle exercise (PFME); and 2: the association of these factors with parity in pregnant women in Gondar, Ethiopia. A facility-based cross-sectional study was performed in the Central Gondar zone, northwest Ethiopia between February and April 2021. The associations between parity and knowledge of POP and UI, and knowledge, attitude, and practice towards PFME were estimated using logistics regression models and presented as crude and adjusted odds ratios with 95% confidence intervals. Nulliparous women were used as the reference. Adjustments were made for maternal age, antenatal care visits, and level of education. The study sample comprised 502 pregnant women: 133 nulliparous, and 369 multiparous. We found no association between parity and knowledge of POP, UI, or knowledge, attitude, and practice toward PFME. The sum score indicated poor knowledge about both POP, UI, and PFME in the study population, and poor attitude and practice of PFME. Despite a high attendance in antenatal care services, knowledge, attitude, and practice were poor, indicating a need for quality improvement of the services.

Knowledge of women during the third trimester of pregnancy regarding pelvic floor disorders

INTRODUCTION AND HYPOTHESIS

The objective was to examine knowledge regarding pelvic floor disorders (PFDs) among women during the third trimester of pregnancy.

METHODS

A cross-sectional study was conducted at a large teaching medical center in Israel between June and September 2020. Women in their third trimester (N = 649) were asked to complete the validated Hebrew and Arabic versions of the Prolapse and Incontinence Knowledge Questionnaire (PIKQ). The PIKQ instrument examines the knowledge of two major PFDs: urinary incontinence (UI) and pelvic organ prolapse (POP). The study population included women over 18 years of age, in the third trimester, who speak and read Hebrew or Arabic fluently. Two separate scores were calculated, one for each section of the PIKQ. The association of questionnaire scores with the different independent variables was examined using Student's t test or one-way ANOVA. Correlations were examined using Pearson's or Spearman's correlation coefficient.

RESULTS

The Hebrew version was filled out by 405 women, and 244 women completed the Arabic version. The average questionnaire scores were 7.65 ± 2.8 and 5.32 ± 2 for the UI and POP sections respectively. Significantly higher average scores in both the UI and the POP sections were noted among health care workers (UI: 10.19 ± 2.3 vs 7.34 ± 2.6, p < 0.001; POP: 8.27 ± 2.7 vs 4.97 ± 2.6, p < 0.001), women with higher education (p < 0.001 in both parts) and those with higher incomes (p < 0.001 for both parts).

CONCLUSIONS

Knowledge of PFD among women in the third trimester of pregnancy in Israel was found to be low. Founding educational programs for targeted groups may improve both the knowledge of PFD and the quality of life for these women.

Pelvic floor dysfunction in rural postpartum mothers in the United States: prevalence, severity, and psychosocial correlates

Pelvic floor dysfunction (PFD) is a common gynecological problem; however, women residing in rural communities may refrain from seeking treatment for PFD. The purpose of this study was to characterize severity of PFD among postpartum women residing in rural communities (<50,000 residents) in the United States and explore the demographic and psychosocial correlates of PFD.

METHODS

A survey packet comprised of the Pelvic Floor Disability Index (PFDI-20) and Prolapse and Incontinence Knowledge Questionnaire (PIKQ) as well as the Edinburgh Perinatal Depression Screening (EPDS), items from the Canadian Sexual Health Indicator (CSHI) survey, and demographic questions were distributed via electronic link following recruitment using social media. Descriptive statistics were calculated, and multivariate logistic regression was used to assess the factors associated with PFDI-20 score.

RESULTS

Participants (n = 383) have limited pelvic health knowledge (PIKQ) despite self-reporting moderate symptoms of dysfunction (PFDI-20). Over half of women scored ≥14 on the EPDS, indicating probable depression. Women with high scores on the EPDS had greater odds of reporting moderate/severe PFD. Women that identified as Black and/or having a college degree were more likely to report moderate/severe PFD.

CONCLUSION

Rural women require further support to improve their physical and psychological health in the postpartum period.

International Urogynecology Consultation: Patient Reported Outcome Measures (PROs) use in the evaluation of patients with pelvic organ prolapse

INTRODUCTION AND HYPOTHESIS

Patient-reported outcome measure instruments include patient-reported outcomes (PROs) and patient-reported goals (PRGs), which allow practitioners to measure symptoms and determine outcomes of treatment that matter to patients.

METHODS

This is a structured review completed by the International Urogynecology Consultation (IUC), sponsored by the International Urogynecological Association (IUGA). The aim of this working group was to evaluate and synthesize the existing evidence for PROs and PRGs in the initial clinical work-up/evaluation and research arena for patients with pelvic organ prolapse (POP).

RESULTS

The initial search generated 3589 non-duplicated studies. After abstract review by 4 authors, 211 full texts were assessed for eligibility by 2 writing group members, and 199 studies were reviewed in detail. Any disagreements on abstract or full-text articles were resolved by a third reviewer or during video meetings as a group. The list of POP PROs and information on PRGs was developed from these articles. Tables were generated to describe the validation of each PRO and to provide currently available, validated translations.

CONCLUSIONS

All patients presenting for POP should be evaluated for vaginal, bladder, bowel and sexual symptoms including their goals for symptom treatment. This screening can be facilitated by a validated PRO; however, most PROs provide more information than needed to provide clinical care and were designed for research purposes.

Prevalence, Knowledge and Awareness of Pelvic Floor Disorder among Pregnant Women in a Tertiary Centre, Malaysia

Pelvic floor disorders are common and of concern, as the majority of maternity healthcare providers seldom discuss this issue with patients compared to other antenatal issues. The aim of this study is to determine the prevalence and to assess the knowledge and awareness of pelvic floor disorder (PFD) among pregnant women in a tertiary centre in Malaysia. We also aim to assess the association between women’s risk factors regarding their knowledge and awareness of pelvic floor disorder so that primary prevention strategies can be planned, initiated and implemented in the future. This is a cross-sectional study with a total of four hundred twenty-four pregnant women that were recruited over a 6-month duration from May to November 2017 in a tertiary centre in Malaysia. The Pelvic Floor Distress Inventory (PFDI-20) was used to evaluate pelvic floor distress symptoms during pregnancy, namely urinary incontinence, pelvic organ prolapse and faecal incontinence. A validated Prolapse and Incontinence Knowledge Questionnaire (PIKQ), which consists of 24 items, was used to assess respondents’ knowledge about urinary incontinence (UI) and pelvic organ prolapse (POP). A total of 450 participants were approached, but 424 participants agreed to participate, showing a response rate of 94.3%. The median age was 31.5 years old, and 33.3% were primiparity. Overall, 46.1% of pregnant women had at least one symptom of pelvic floor disorder during pregnancy. Of these, 62.3% experienced urinary incontinence, 41.1% experienced symptoms of pelvic organ prolapse, and 37.8% experienced symptoms of faecal incontinence. The overall median score of PIKQ was 12.0 (8.0, 17.0). The median score for PIKQ—UI was 7.0 (5.0, 9.0) and the median score for PIKQ—POP was 6.0 (4.0, 8.0). There were 341 (80.4%) pregnant women that had a low level of knowledge in UI, and 191 (45.0%) had a low level of knowledge in POP. Having a tertiary level of education and receiving antenatal specialist care were both associated with better proficiency in both the PIKQ—UI (p < 0.001) and PIKQ—POP (p < 0.001) subscales. Pelvic floor disorder during pregnancy was common. A knowledge of pelvic floor disorder was lacking among pregnant women in this study. Having a tertiary education and receiving antenatal specialist care were both associated with better knowledge proficiency. This study hopefully serves as a basic platform for future educational programs to bridge the knowledge gaps in PFD among pregnant women.

"Things Are Happening That I Don't Understand": A Narrative Exploration of the Chaos of Living with Pelvic Floor Disorders

Pelvic floor disorders (PFDs), including fecal and urinary incontinence as well as pelvic organ prolapse, are common medical issues faced by one-third of all women across the lifespan. Despite this prevalence, many women are unaware of them, have highly stigmatized perceptions of them, and thus do not actively seek support or treatment for them. Given that PFDs can drastically impact quality of life to the point of social isolation and depression, this study examines chaos and desire as both lived and storied constructs that ultimately influence whether and how women with PFDs assert control over their social and corporeal disruption. Guided by narrative sensibilities and informed by semi-structured interviews with 22 women living with varying PFDs, our analysis highlights how chaos serves as a catalyst for continued chaos (i.e. barriers to seeking medical care), mitigation (i.e. resignation and/or public bodily containment), and/or change (i.e. motivations to seek medical care). These findings offer both theoretical and practical implications for helping individuals grappling with the dis-ease of PFDs (i.e. patients, providers, and practitioners) to envision and act otherwise.

Validation of the hebrew version of the prolapse and incontinence knowledge questionnaire (PIKQ) during pregnancy

INTRODUCTION AND HYPOTHESIS

Pregnancy and delivery have a major effect on pelvic floor disorders. Assessing knowledge regarding pelvic floor disorders in childbearing age women and appropriate interventions will enable women to seek appropriate medical advice once pelvic floor disorders have developed. The purpose of this study was to validate the prolapse and incontinence knowledge questionnaire in the Hebrew language.

METHODS

Translation of the prolapse and incontinence knowledge questionnaire to the Hebrew language according to international recommended guidelines. A study was conducted to validate the questionnaire. The study took place between June to September 2020 in a tertiary medical center in Israel. A total of 240 third trimester pregnant women completed the Hebrew version of the prolapse and incontinence knowledge questionnaire. Construct validity, criterion validity and reliability tests were performed.

RESULTS

Factor analysis of the Hebrew version of the prolapse and incontinence knowledge questionnaire demonstrated 12 strong positive factor loadings to one principal factor in the prolapse and incontinence knowledge questionnaire-pelvic organ prolapse domain (FL > 0.3) and 10/12 in the prolapse and incontinence knowledge questionnaire-urinary incontinence domain. The Hebrew prolapse and incontinence knowledge questionnaire was found to have internal consistency, with Cronbach alpha coefficient of 0.745 for the urinary incontinence domain and 0.796 for the pelvic organ prolapse domain.

CONCLUSIONS

The Hebrew version of the prolapse and incontinence knowledge questionnaire is a new, reliable, consistent, and valid instrument to examine the level of knowledge regarding pelvic floor disorders in Hebrew-speaking pregnant women.

The effect of pelvic floor exercises performed with EMG biofeedback or a vaginal cone on incontinence severity, pelvic floor muscle strength, and quality of life in women with stress urinary incontinence: a randomized, 6-month follow-up study

INTRODUCTION AND HYPOTHESIS

The objective was to assess the effectiveness of pelvic floor exercises performed with electromyographic (EMG) biofeedback or a vaginal cone on incontinence severity, muscle strength, social activity level, quality of life, treatment success, and treatment satisfaction in women with stress urinary incontinence (SUI).

METHODS

This prospective, randomized study included 40 female patients diagnosed with SUI. Patients were randomly divided into two groups as the group receiving pelvic floor muscle exercise (PFME) with a vaginal cone at home (n = 20) and the group receiving PFME with EMG biofeedback in the hospital (n = 20). The measurement of urinary incontinence severity with a 1-h pad test, assessment of social activity with the social activity index (SAI), assessment of incontinence-specific quality of life, manual measurement of pelvic floor muscle strength, and the assessment of treatment satisfaction were performed in the pre-treatment period and post-treatment at 3 and 6 months.

RESULTS

In intragroup analyses, an improvement was observed in both groups in the pad test, muscle strength, SAI, quality of life, and treatment satisfaction measurement compared with the pre-treatment period (p < 0.05). No significant difference was found between the groups in terms of assessment parameters in intergroup analyses during follow-up (p > 0.05).

CONCLUSION

It was concluded that both EMG biofeedback assisted PFME and PFME with a vaginal cone had curative effects on incontinence in patients with SUI. We believe that both protocols can be used as acceptable and effective conservative therapy methods in the treatment of women with SUI considering their preference.

Validation of the Thai version of the Prolapse and Incontinence Knowledge Questionnaire (PIKQ)

Introduction and hypothesis

The Prolapse and Incontinence Knowledge Questionnaire (PIKQ) was developed and validated to assess women’s knowledge regarding etiology, diagnosis and treatment of pelvic organ prolapse (POP) and urinary incontinence (UI). We aimed to translate and validate a Thai version of the PIKQ to use as a tool to evaluate knowledge of POP and UI among Thai-speaking women.

Methods

The English PIKQ, which comprises the PIKQ-POP and PIKQ-UI sections, was translated into Thai. Psychometric properties of the final version of the Thai PIKQ were tested for content validity, construct validity, internal consistency and test-retest reliability among 168 women attending a gynecology clinic and 150 nurses.

Results

Regarding content validity of the final Thai PIKQ, the number of missing items was 0. Participants in the nurse group were more likely than those in the patient group to select the correct answer for all items for the POP scale and UI scale (P < 0.001). For internal consistency testing, Cronbach’s alpha coefficient was 0.745 for the PIKQ-POP and 0.754 for the PIKQ-UI scales, suggesting that the items had relatively high internal consistency. The item-total correlation values ranged from 0.204 to 0.539, showing an adequate correlation of each item with the scale overall. The correlation coefficients between the test and retest for PIKQ-POP and PIKQ-UI were 0.685 and 0.735, respectively (P < 0.001).

Conclusions

The Thai PIKQ is a simple instrument which shows good validity and high reliability and could be a useful tool for assessing knowledge regarding POP and UI in clinical practice.

Spanish Questionnaires for the Assessment of Pelvic Floor Dysfunctions in Women: A Systematic Review of the Structural Characteristics and Psychometric Properties

BACKGROUND

Pelvic floor dysfunctions affect a third of the adult female population, including a large number of clinical conditions, which can be evaluated through validated questionnaires that inform us of the status and perception of women both objectively and subjectively. The main objective of this study was to review and explain the topics of the validated questionnaires in Spanish on pelvic floor dysfunctions and to review their psychometric properties.

METHODS

A systematic review was carried out in the PUBMED and WOS databases. The keywords used were in PUBMED: (((((((("Fecal Incontinence" [Mesh]) OR "Urinary Incontinence" [Mesh]) OR "Pelvic Organ Prolapse" [Mesh]) OR "Pelvic Floor Disorders" [Mesh]) OR "Sexual Dysfunction, Physiological" [Mesh]) OR "Pelvic Girdle Pain" [Mesh]) OR "sexual function" [Title/Abstract]) OR "Prolapse" [Title/Abstract]) AND "Surveys and Questionnaires" [Mesh] AND "Validation" [Title/Abstract] combined with the Boolean operators "AND"/"OR". In contrast, in WOS, a segregated search was carried out with each of the terms of pelvic floor dysfunction together with "Validation" and "Surveys and Questionnaires". All articles published up to 19 November 2021 were considered. Methodological quality was assessed with the COSMIN scale.

RESULTS

A total of 687 articles were identified, of which 13 were included. The evaluated questionnaires and the structural characteristics and psychometric properties of each of them were collected.

CONCLUSION

The Spanish versions of the questionnaires show good basic structural and psychometric characteristics for the evaluation of patients with pelvic floor dysfunctions and that they resemble other versions of the same questionnaire published in other languages.

Validation of a Spanish Version of the Prolapse and Incontinence Knowledge Questionnaire

OBJECTIVE

The objective of this study was to validate a Spanish version of the Prolapse and Incontinence Knowledge Questionnaire (PIKQ).

METHODS

Validation and reliability testing of the Spanish version of the PIKQ was conducted in 2 phases. In the first phase, a translation-back-translation method by 6 bilingual researchers was utilized to generate a final Spanish translation. In the second phase, bilingual women were randomized to complete the Spanish or English version first, followed by the alternate language. Agreement between individual items from English and Spanish versions was assessed by percent agreement and κ statistics. Intraclass correlation coefficients compared overall PIKQ scores and pelvic organ prolapse (POP) and urinary incontinence (UI) subscores. To establish test-retest reliability, we calculated Pearson correlation coefficients. In order to have a precision of 10% for 90% agreement, so that the lower 95% confidence interval would not be less than 80% agreement, 50 bilingual participants were required.

RESULTS

Fifty-seven bilingual women were randomized and completed both versions of the PIKQ. Individual items showed 74%-97% agreement, good to excellent agreement (κ = 0.6-0.89) for 9 items and moderate agreement (κ = 0.4-0.59) for 14 items between English and Spanish PIKQ versions. Intraclass correlation coefficients of the overall score and POP and UI subscores showed excellent agreement (intraclass correlation coefficient = 0.81-0.91). Pearson correlation coefficients between initial and repeat Spanish scores were high: overall (r = 0.87) and for POP (r = 0.81) and UI subscores (r = 0.77).

CONCLUSIONS

A valid and reliable Spanish version of the PIKQ has been developed to assess patient knowledge about UI and POP.

Do community-dwelling pregnant women know about pelvic floor disorder?

Our study aimed to assess the knowledge and awareness regarding pelvic floor disorders (PFDs) among pregnant women. We additionally evaluated whether the knowledge of PFDs was different in relation to gestational age, parity, the attendance to an antenatal education (ANE), and history of urinary incontinence (UI) and/or pelvic organ prolapse (POP). A cross-sectional descriptive study was conducted in pregnant women from all trimesters of pregnancy. The Prolapse and Incontinence Knowledge Questionnaire (PIKQ) and three questions were used for knowledge and awareness. Two hundred and forty-one women participated in the study. Of them, 18.6% (n = 46) and 3.6% (n = 9) had UI and POP, respectively. The median of the PIKQ-UI and the PIKQ-POP scores were 6 (min-max: 0-11) and 5 (min-max: 0-12), respectively. The median PIKQ-UI and PIKQ-POP scores were higher in women who had attended ANE. There was no significant difference in terms of gestational age, parity, the attendance to ANE, and the history of pelvic floor disorder (p > .05). Knowledge and awareness were low among the women in all trimesters. Education programs involving pelvic floor training should be organized for pregnant women.

What do female university students know about pelvic floor disorders? A cross-sectional survey

INTRODUCTION AND HYPOTHESIS

Pelvic floor dysfunction (PFD) is common in women but few seek medical attention. Poor recognition of the condition as pathological and unawareness of treatments may account for low consultation rates.

METHODS

This cross-sectional study was based on an online survey that was responded to in February and March 2020 by 768 female university students. Knowledge of PFD was assessed using the Prolapse and Incontinence Knowledge Questionnaire (PIKQ). Descriptive and inferential analyses were performed using IBM-SPSS (V26.0).

RESULTS

Respondents had poor knowledge of PFD and especially of pelvic organ prolapse. Health science students (n = 531; 69.1%) obtained significantly higher scores (p < 0.001) than other students (n = 237; 30.9%). Those who had received information on how to perform pelvic floor muscle training were more likely to score higher than those who had not received previous information.

CONCLUSIONS

While health science students have better knowledge of PFD than other students, university students in general are little aware of PFD. Most students considered the issue of PFD to be important and wanted more information. Our findings may be useful in planning strategies to raise women's awareness of PFD and its prevention and treatment.

Association of Knowledge and Presence of Pelvic Floor Disorders and Participation in Pelvic Floor Exercises: A Cross-sectional Study

INTRODUCTION

Women's baseline knowledge of pelvic floor exercises (PFEs) and pelvic floor disorders (PFDs) is not well established, as is their knowledge regarding PFE and participation in such exercise. The aim of our study was to assess baseline PFD and PFE knowledge and to determine if knowledge in any way influenced participation in PFEs.

METHODS

This was an institutional review board-approved, cross-sectional survey administered to women 18 years or older. We included all women who completed the survey, of which 3733 met the criteria. A survey-based questionnaire was used to query lower urinary tract symptoms, PFD, knowledge, and frequency of participation in PFEs.

RESULTS

Of those who responded, the mean incontinence knowledge score was 9.2 ± 2.6, whereas the mean score for pelvic organ prolapse (POP) knowledge was 6.8 ± 3.6. Of the respondents, 92.5% reported being familiar with Kegel exercises. The majority of respondents reported that they did not participate in PFEs (57.4%). Those with POP were more likely to do daily PFEs than those without POP, 34.8% versus 16.4% (P < 0.001). Stress urinary incontinence did not influence frequency of performing PFEs.

CONCLUSIONS

Our study demonstrated that while baseline knowledge of POP and incontinence knowledge were high in this patient population, the majority of participants did not participate in PFE. Participants with POP were more likely to partake in daily PFE. A gap exists between knowledge and willingness to participate in PFE. Bridging this gap may be significantly impactful for women's health.

How Do We Assess Patient Skills in a Competence-Based Program? Assessment of Patient Competences Using the Spanish Version of the Prolapse and Incontinence Knowledge Questionnaire and Real Practical Cases in Women with Pelvic Floor Disorders

Therapeutic patient education programs must assess the competences that patients achieve. Evaluation in the pedagogical domain ensures that learning has taken place among patients. The Prolapse and Incontinence Knowledge Questionnaire (PIKQ) is a tool for assessing patient knowledge about urinary (UI) and pelvic organ prolapse (POP) conditions. The aim of this study was to translate the Prolapse and Incontinence Knowledge Questionnaire (PIKQ) into Spanish and test its measurement properties, as well as propose real practical cases as a competence assessment tool. The cross-cultural adaptation was conducted by a standardized translation/back-translation method. Measurement properties analysis was performed by assessing the validity, reliability, responsiveness, and interpretability. A total of 275 women were recruited. The discriminant validity showed statistically significant differences in the PIKQ scores between patients and expert groups. Cronbach's alpha revealed good internal consistency. The test-retest reliability showed excellent correlation with UI and POP scales. Regarding responsiveness, the effect size, and standardized response mean demonstrated excellent values. No floor or ceiling effects were shown. In addition, three "real practical cases" evaluating skills in identifying and analyzing, decision making, and problem-solving were developed and tested. The Spanish PIKQ is a comprehensible, valid, reliable, and responsive tool for the Spanish population. Real practical cases are useful competence assessment tools that are well accepted by women with pelvic floor disorders (PFD), improving their understanding and their decision-making regarding PFD.

Knowledge of pelvic floor disorders amongst immigrant women in Canada

INTRODUCTION AND HYPOTHESIS

Pelvic floor disorders (PFD) have a detrimental effect on quality of life. Despite the available treatments, women often do not seek medical care. Patient knowledge has been identified as a major barrier to accessing care. The objective of this study was to assess knowledge on PFD amongst women in Edmonton, hypothesizing that immigrant women are less knowledgeable about PFD than Canadian-born women.

METHODS

A cross-sectional study of immigrant women and Canadian-born women was conducted. Immigrant women were recruited at the Multi-Cultural Health Brokers Co-op (MCHB) and Canadian-born women at a colposcopy clinic. The Prolapse and Incontinence Knowledge Questionnaire (PIKQ) was administered. Scores for UI and POP were calculated and compared using a Mann-Whitney U test and a t test. A subgroup analysis of immigrants was carried out according to length of stay in Canada and ethnicity. Ethics approval was obtained from the University of Alberta Human Research Ethics Office.

RESULTS

A total of 106 immigrants and 102 Canadian-born women completed the PIKQ. The overall PIKQ scores were 12.7 for immigrant women and 14.4 for Canadian-born women (p = 0.04). Immigrant women who had lived in Canada for >10 years had higher scores (mean = 13.2) compared with women with less than 10 years in Canada (mean = 11.8). Women from South Asia had higher overall PIKQ scores (mean = 14.6) whereas women from sub-Saharan Africa had the lowest scores (mean = 12.1).

CONCLUSIONS

Immigrant women in Edmonton were found to have less knowledge on PFD than Canadian-born women.

Obstetric Nurses' Knowledge, Attitudes, and Professional Support Related to Actual Care Practices About Urinary Incontinence

OBJECTIVES

The objective of this study was to evaluate obstetric nurses' knowledge, attitudes, and practices (KAP) toward urinary incontinence (UI) during pregnancy and identify factors associated with their actual specific care practices for recommending pelvic floor muscle training (PFMT).

METHODS

A cross-sectional study was conducted among obstetric nurses attending an academic conference about perinatal care in China. Data were collected through a self-administered questionnaire, including demographic and professional information, professional supports included clinical protocol and learning experience, knowledge, attitudes, and practices of UI.

RESULTS

Four hundred and seven obstetric nurses completed the survey (89.8% response rate). The correct answer rates of the vast majority of knowledge items was more than 80%. The majority of participants strongly agreed that antenatal PFMT is effective in UI treatment and prevention (69.5% and 69.0% respectively). Although only less than 30% of participants always recommended PFMT to incontinent or continent pregnant women (29.5% and 25.3%, respectively), obstetric nurses with clinical protocol, learning experience, and positive attitudes were more likely to recommend PFMT for treating UI (odds ratio [OR], 2.165, P < 0.001; OR, 1.759; P = 0.014; OR, 2.326; P < 0.001, respectively). Obstetric nurses with clinical protocol and positive attitudes were more likely to recommend PFMT for preventing UI (OR, 2.252; P < 0.001; OR, 1.693; P = 0.005, respectively).

CONCLUSIONS

Most obstetric nurses have good knowledge and positive attitudes toward UI during pregnancy, but fail to deliver care for it. Clinical protocol, learning experience, and positive attitudes are facilitators of their actual specific care practices for recommending PFMT. This finding suggests the need for developing clinical protocols and education programs regarding UI during pregnancy.

What Does Your Pelvic Floor Do for You? Knowledge of the Pelvic Floor in Female University Students: A Cross-sectional Study

OBJECTIVES

To assess the knowledge of the pelvic floor in female university students, including knowledge of pelvic floor structure, function, pelvic floor dysfunction, and pelvic floor muscle exercises (PFMEs).

METHODS

The study design is a cross-sectional study via online questionnaire with convenience sampling of female students registered at University College Cork, Ireland for the academic year 2018 to 2019. An online questionnaire was distributed to students at their registered email addresses. Overall knowledge was assessed through 15 questions, looking at pelvic floor structure, function, pelvic floor dysfunction and PFMEs. A score of 1 was allocated to each correct question, with a maximum possible score of 15. Only respondents who answered all 15 questions were included in the analysis. Ethical approval was granted by the Clinical Research and Ethics Committee, Cork, Ireland, on January 4, 2019.

RESULTS

Nine hundred thirty-eight responses were received. There were 72.6% (n = 640) students who had never received information on the pelvic floor. There were 83.9% (n = 691) students who reported that they thought it was important to exercise the pelvic floor. The mean overall knowledge score of 792 respondents was 9.57 (SD, ± 2.72). There was a statistically significant difference (P < 0.001) in the overall knowledge between the students in the school of medicine and health (n = 307, mean = 11.8, SD = 2.35) and the students of other schools (n = 529, mean = 9.39, SD = 2.88).

CONCLUSIONS

Knowledge of the pelvic floor in female university students is poor. Further interventions should aim to improve knowledge of the pelvic floor and encourage correct performance of PFMEs in college students.

The relationship between pelvic organ prolapse and short birth intervals in a rural area of Nepal

Background

Pelvic organ prolapse (POP) is one of the main contributors to reproductive health problems that affect women’s quality of life. Previous studies have reported the risk factors and prevalence of POP. The aim of this study is to examine the association between POP and short birth intervals in a rural area of Nepal.

Methods

A cross-sectional study was conducted in Panchapuri municipality, located in Surkhet District of Karnali Province in Nepal. A questionnaire was used to collect information on POP, birth intervals, and other known confounding factors, such as age and parity. Multiple logistic regression analysis was used to examine the association between minimum birth intervals and POP.

Results

The study recruited 131 women. The prevalence of POP was 29.8%. The mean (SD) of maternal age was 32.3 (0.7) years. The median parity was 2, with a range of 2–6 children. More than half (64.9%) of the women reported a minimum birth interval of less than 2 years. Maternal age at birth, minimum birth interval, parity, and latest birth interval were significantly associated with POP in univariate analyses. After adjusting for the potential confounding factors such as age and occupation, the minimum birth interval was significantly associated with POP [AOR = 3.08, 95% CI 1.04–9.19].

Conclusion

The prevalence of POP was high in this rural area of Nepal. Age, parity, occupation, and minimum birth interval were significantly associated with POP.

Supplementary Information

The online version contains supplementary material available at 10.1186/s41182-021-00298-z.

Decision Aid Video for Treatment Selection in Latinas With Symptomatic Pelvic Organ Prolapse: A Randomized Pilot Study

OBJECTIVES

To assess impact of a decision aid video in Latina patients with symptomatic pelvic organ prolapse (POP) on knowledge, satisfaction and decisional conflict related to initial treatment selection.

METHODS

Pilot study with randomized prospective design. Thirty Latina women with symptomatic POP were randomized to a decision aid intervention plus standard care (N = 15) or standard care alone (N = 15) group. Decision aid intervention consisted of a 10-minute video presented at time of initial evaluation for POP. Outcome measures included the Prolapse and Incontinence Knowledge Quiz ("Knowledge"), the Satisfaction with Decision ("Satisfaction") and Decisional Conflict (DCS) scales, and were assessed at 4 different timepoints: after initial visit, and at 1, 3 and 6 months after. Data was analyzed using repeated-measures ANOVA and pairwise between-group comparisons.

RESULTS

Demographic and baseline data were similar between groups. There was a significant interaction between groups and time on the Knowledge scores (P = 0.03). Knowledge scores were higher at the initial visit in the intervention group (10.6 ± 0.8 vs 9.53 ± 1.4, P = 0.014). Satisfaction scores were lower in the intervention group on longitudinal analysis, indicating higher satisfaction (P = 0.02). There was no difference on overall Decisional Conflict scores between groups. The intervention group had lower scores on the "effective decision" DCS subscale at 3 and 6 months and "informed" DCS subscale at 3 months.

CONCLUSIONS

A decision aid video intervention in Latina women with POP used at the time of initial evaluation may help the patient make a more informed treatment decision by increasing condition-related knowledge and lead to greater long-term satisfaction.

[Knowledge of pelvic floor disorders in peripartum women: A systematic review]

BACKGROUND

Pregnancy and postpartum are periods of life during which pelvic floor disorders (PFD) can occur.

PURPOSE

The aim of this review is to make an inventory of what women in the perinatal period know about PFD, their risk factors and preventive measures.

DOCUMENTARY SOURCES

We performed a systematic review of the literature in PubMed, Cochrane Library, LISSA and Kinédoc databases by using the keywords "knowledge", "awareness", "beliefs", "pelvic floor", "postpartum" and "pregnancy". We included studies written in English or French, assessing women's knowledge using a questionnaire and published up to May 2020 with no restriction on start date.

SELECTION OF STUDIES

A total of 14 cross-sectional studies were selected from 240 studies, with a sample size of 3950 participants.

RESULTS

The topics covered in the questionnaires were anatomy, pelvic floor function, all PFD, risk factors and preventive measures. Overall, women's knowledge of the perinatal period is limited. It has also been shown that education of women on risk factors and preventive measures regarding the occurrence of PFD was incomplete.

CONCLUSION

To conclude, the knowledge of women in the perinatal period about PFD is limited.

Incontinence Quiz: Translation, validation, and reproducibility in Portuguese women

AIM

The purpose of the present study was to translate and validate the Incontinence Quiz (IQ) questionnaire into a Portuguese version.

METHODS

The Portuguese version of the 14-item Incontinence Quiz was prepared following translation and back-translation procedures and was tested on a pilot group of 10 women. Internal consistency (Cronbach's α), test-retest reliability (intraclass correlation coefficient [ICC]), and construct validity (using two indicators: education level and being a qualified health professional) were assessed in 141 women from the staff of two higher education institutions. Participant's socio-demographic characteristics were collected by questionnaire.

RESULTS

The translation and back-translation process was performed without constraints. Cronbach's α ranged from 0.696 (Item 13) to 0.748 (Item 6), and global Chronbach's α was  .740. ICC values for the IQ total score were  .78, .57, and .79 for correct, wrong, and do not know answers, respectively. Both economic indicators were positively associated with the percentage of correct answers.

CONCLUSIONS

Validity and reliability of the translated Portuguese IQ were achieved which will allow the comparison of results with studies in other cultures.

Women and healthcare providers' knowledge, attitudes and practice related to pessaries for pelvic organ prolapse: A Systematic review

OBJECTIVE

To identify the knowledge, attitudes and practice of women and healthcare professionals in relation to pessary use for POP.

METHOD

This systematic review was carried out in agreement with PRISMA recommendations. PubMed/MEDLINE, SCOPUS, Virtual Health Library, Web of Science, CAPES Periodicals and CINAHL databases were searched for studies without date or language limitations. Search strategies were developed for identifying studies examining knowledge, attitudes and practice toward vaginal pessaries use. Two reviewers independently screened titles and abstracts to identify eligible studies. Data extraction was performed independently in duplicate into a standardized form. Quality of included studies was assessed using the Joanna Briggs Institute quality assessment tool. The protocol was registered with the PROSPERO International prospective register of systematic reviews [CRD42018114236].

RESULTS

Fourteen studies were included. Knowledge and practice were the main domains investigated among patients and professionals, respectively. The results demonstrated poor patient knowledge; however, in urogynecologic patients, knowledge was better. Previous consultation with a Female Pelvic Medicine and Reconstructive Surgery specialist (p = .001) and a higher level of education (p = .006) were associated with improved knowledge of pessary use. Fear of vaginal discharge, irritation, bleeding, and pain were factors that supported the decision not to use a pessary. Previous consultation with a generalist gynecologist (p = .03)and a lower level of education (p = .03) predicted aversion to pessary use. Providers demonstrated adequate knowledge and recommended pessary in 86.4% to 98.0% of cases. Having specialist and pessary management training were some factors that influenced a better attitude towards pessaries among health professionals.

CONCLUSION

The knowledge, attitudes and practice of women and health care providers about pessary use are seldom investigated. Developing a psychometrically valid instrument for assessment of knowledge, attitudes and practice is desirable to examine the complex interactions between these three constructs, expose barriers to pessary care, and develop targeted educational interventions.

Knowledge of pelvic floor disorders in women seeking primary care: a cross-sectional study

Background

Pelvic floor disorders including urinary incontinence (UI) and pelvic organ prolapse (POP) are common conditions; however, most women with these symptoms do not seek care. Failure to seek care may be related to misconceptions about these conditions. The aim of this study was to assess the baseline knowledge of UI and POP among adult women presenting to primary care clinics, as well as factors associated with knowledge levels.

Methods

A survey with questions from previously validated UI and POP knowledge questionnaires (PIKQ-UI and PIKQ-POP, respectively) was self-administered to a cross-sectional group of adult female patients presenting to three primary care clinics: geriatric, community-based, and hospital-based. Participants’ demographics and medical histories were compared using ANOVA or Kruskal-Wallis for continuous variables and Chi-square test or Fisher’s exact test for categorical variables. In order to compare various covariates with knowledge non-proficiency on PIKQ-UI and PIKQ-POP scales, unadjusted and adjusted ORs with 95% CIs were calculated using bivariate analysis and multivariate logistic regression, respectively.

Results

Of 346 participants, knowledge non-proficiency was similar and consistent across clinic sites and reached 72.0% for UI and 53.6% for POP. On multivariate analysis, lower educational attainment, being unaware of UI or POP as medical conditions, and having no history of care-seeking for these conditions were significantly associated with knowledge non-proficiency on UI, POP, or both.

Conclusions

Knowledge non-proficiency for UI and POP is common among women presenting for primary care. For UI, healthcare providers should assess patients’ actual understanding of the disease, especially among those with lower educational attainment, to eliminate any possible misconceptions. For POP, the focus should be on increasing awareness of this disease, as many women may have not previously heard of this condition. Simple strategies may increase knowledge in these areas and change care-seeking behaviors.

Study registration

None.

Baseline Understanding of Urinary Incontinence and Prolapse in New Urogynecology Patients

OBJECTIVES

Investigators sought to assess whether age was related to patient understanding of pelvic floor disorders; given studies show that increased age is associated with lower health literacy.

METHODS

This was a cross-sectional survey of new urogynecology patients. Enrolled participants completed a survey including demographics, history of urinary incontinence (UI) and pelvic organ prolapse symptoms and treatment, the Prolapse and Incontinence Knowledge Questionnaire (PIKQ), self-assessment of UI and prolapse knowledge, and a pelvic anatomy diagram to label. To achieve 80% power to detect a 2-point difference in PIKQ score, 33 subjects were required per age group (<65 and ≥65 years old).

RESULTS

One hundred thirty-five of 160 new urogynecologic patients completed the survey (84% response rate). Thirty-seven participants were older than 65 years, and 98 were younger than 65 years. Total PIKQ scores (maximum, 24), the primary outcome, for the older and younger groups were 15.3 and 15.0, respectively (P = 0.7). The 2 groups self-rated UI and prolapse knowledge similarly, rating knowledge as excellent, very good, or good in 60% (P = 0.3) and 40% (P = 0.2) of subjects, respectively.

CONCLUSIONS

Baseline patient understanding of UI and pelvic organ prolapse was low as assessed by PIKQ score and was not influenced by age.

Is Something Missing From Antenatal Education? A Survey of Pregnant Women's Knowledge of Pelvic Floor Disorders

OBJECTIVE

This study aimed to describe the knowledge on pelvic floor disorders among a cross section of pregnant women.

STUDY DESIGN

This was an institutional review board-approved cross-sectional survey study of pregnant women with a gestational age of more than 18 weeks at a single tertiary care institution. Participants completed the validated 24-item Prolapse and Incontinence Knowledge Questionnaire, and responses were graded to determine a raw accuracy score (0-100%). Proficiency in the topic was defined as a score greater than 80% on the urinary scale and greater than 50% on the prolapse scale.

RESULTS

Four hundred two women completed the survey. Mean ± SD raw accuracy in urinary incontinence was 66% ± 12%, and mean ± SD raw accuracy in pelvic organ prolapse was 41% ± 17%. These results were not significantly different among age or ethnic groups. Pregnant women were more likely to know that delivery could lead to incontinence (62%) than to pelvic organ prolapse (42%; P = 0.02), and 83% knew that pelvic floor exercises could prevent urinary incontinence. Proficiency was low among the population on both scales.

CONCLUSIONS

Pregnant women have limited knowledge about pelvic floor dysfunction despite being at increased risk for these conditions during and after their pregnancies. This is an area where patient education and empowerment during routine prenatal care could improve.

Nursing Home Residents' Level of Knowledge About Urinary Incontinence

Background

A common problem in nursing home residents, urinary incontinence (UI) can lead to hygiene and skin problems, sleep disturbance, and decreased quality of life. This study evaluated the level of knowledge regarding UI among nursing home residents in Muğla, Turkey.

Methods

This study included 64 (19 females, 45 males) nursing home resident volunteers. Their physical and sociodemographic characteristics; daily living activities (Barthel Index); and the presence, frequency, severity, and type of UI as well as its impact on daily living were evaluated (International Consultation on Incontinence Questionnaire-Short Form) and history of treatment was queried. An Incontinence Quiz was used to assess the residents’ knowledge of incontinence.

Results

The participants were living in nursing homes for 34.48±33.16 months. Their educational level was low and most were single. The mean Barthel Index score was 89.75±13.00. Twenty-five participants had UI (18.8% urge, 4.7% stress, 15.6% mixed/other type), and the mean International Consultation on Incontinence Questionnaire-Short Form score was 8.08±4.24. Forty-four percent of the participants had no treatment and none had physiotherapy for incontinence. The mean Incontinence Quiz score was 4.88±1.96, indicating a low level of knowledge. The items with the highest ratio of incorrect responses (second and 14th) were related to the causes of incontinence and care seeking.

Conclusion

These findings underscore the necessity of increasing knowledge among nursing home residents about the reasons and health care options for UI. Further studies on appropriate strategies to improve UI knowledge in this population will be of great value.

Urinary Incontinence and Pelvic Organ Prolapse Knowledge, Care-Seeking, and Embarrassment in Women Planning Bariatric Surgery: A Cross-sectional Study

OBJECTIVE

The objective of this study was to assess whether patients seeking bariatric surgery were at least as proficient in urinary incontinence (UI) and pelvic organ prolapse (POP) knowledge as the general population. Our secondary objective was to determine care-seeking and impact of embarrassment on knowledge of pelvic floor disorders (PFDs).

METHODS

An anonymous survey was administered to adult women who attended a bariatric surgery information session from May 2015 to January 2016. The comprehensive survey included multiple data points and the Prolapse and Incontinence Knowledge Quiz. The study population was compared with a general population described in a previously published study.

RESULTS

Three hundred fifteen participants completed the survey (88% response rate). Mean ± SD age was 41.1 ± 11.3 years (range, 18-69 years), and mean body mass index was 47.4 ± 9.6 kg/m (range, 26.7-104.5 kg/m). A total of 196 women (62.2%) had at least one bothersome PFD symptom. The study population was at least as proficient in UI knowledge as the general population (P < 0.0001), but not for POP knowledge (P < 0.946). Among participants with symptomatic PFD, 91.7% of those with UI symptoms and 70% of those with POP symptoms reported that they would seek care. There was a difference in knowledge proficiency between women who were and were not embarrassed to discuss UI (P = 0.77) or POP (P = 0.99).

CONCLUSIONS

The study population demonstrated less POP knowledge than the general population, but not for UI knowledge. A high proportion of women with UI or POP symptoms would seek care, but embarrassment to discuss UI or POP negatively impacted knowledge.

Women's knowledge, attitude and practice related to urinary incontinence: systematic review

INTRODUCTION

Knowledge, attitude and practice (KAP) investigations lead to an understanding of what a particular population group knows, thinks and does in relation to a certain subject.

METHODS

This systematic review was conducted to identify women's KAP related to urinary incontinence (UI) described in the literature and the measurement/evaluation instruments used. A literature search, up to July 2017, was conducted in PUBMED, SCOPUS and BVS (Virtual Health Library) for articles dealing with women's KAP related to UI that described the validation procedure of any data collection instrument. Articles that investigated exclusively male subjects, provider performance or academic teaching strategies were excluded. Relevant studies were analyzed and briefly summarized.

RESULTS

Initially, 799 articles were retrieved. After applying the inclusion and exclusion criteria, 19 remained for reading and summarizing. There has been interest in identifying and evaluating some of the KAP elements related to UI since 1994, with a wide variety of validated instruments used. Knowledge was evaluated in 15 articles and all concluded that there was misinformation about UI in the populations studied. Seven articles studied the intention to seek healthcare for UI, among which only one evidenced an adequate attitude in more than 70% of the participants. All the articles that investigated practice revealed low rates of seeking care.

CONCLUSIONS

The KAP elements are influenced by specific questions in each of the studied populations, leading to unique results, which indicates the importance of investigations using standardized data collection instruments that have psychometric validity tested in the target populations.

Knowledge of Pelvic Floor Disorders in Obstetrics

OBJECTIVES

The aim of this study was to investigate knowledge and demographic factors associated with a lack of knowledge proficiency about urinary incontinence (UI) and pelvic organ prolapse (POP) among pregnant and postpartum women.

METHODS

This was a cross-sectional survey of women receiving antepartum and postpartum care at 9 Connecticut sites. Knowledge was assessed using the validated Prolapse and Incontinence Knowledge Questionnaire. Lack of knowledge proficiency was defined as less than 80% and less than 50% correct responses on the Prolapse and Incontinence Knowledge Questionnaire UI and POP subscales. Logistic regression was used to evaluate unadjusted and adjusted odds ratios (ORs) and 95% confidence intervals (CIs). P < 0.05 was considered statistically significant.

RESULTS

Surveys from 399 diverse pregnant and postpartum women were analyzed. Three quarters showed a lack of knowledge proficiency about UI and POP (74.2%, 70.6%). After adjustment, increased odds of lacking UI knowledge proficiency were associated with primiparity versus nulliparity (OR, 4.73; 95% CI, 2.24-9.98), Hispanic versus white race (OR, 2.72; 95% CI, 1.18-6.01), and having a high school diploma/General Education Development/less (OR, 3.17; 95% CI, 1.34-7.48) or some college (OR, 2.55; 95% CI, 1.08-6.01) versus bachelor's degree; greater lack of POP knowledge proficiency was associated with having a high school diploma/General Education Development versus bachelor's degree (OR, 2.11; 95% CI, 1.05-4.26) and never seeing a urologist/urogynecologist versus those who had (OR, 0.30; 95% CI, 0.12-0.77). Women working in a medical field versus those who did not demonstrated decreased odds of lacking UI and POP knowledge proficiency (ORs, 0.26 [95% CI, 0.13-0.52] and 0.38 [95% CI, 0.21-0.70]).

CONCLUSIONS

Pregnant and postpartum women lack knowledge about UI and POP. Preconceptional counseling provides an opportunity for educational intervention.

Pregnancy-Associated Pelvic Floor Health Knowledge and Reduction of Symptoms: The PREPARED Randomized Controlled Trial

OBJECTIVES

Pregnancy and childbirth can lead to pelvic floor disorders, yet this topic is not routine in antenatal education. We aimed to determine the impact of a pregnancy workshop on women's postpartum pelvic floor health knowledge, performance of pelvic floor muscle exercises (PFME), symptoms, condition-specific quality of life, mode of delivery, and satisfaction.

METHODS

This was a RCT. Pregnant primiparous women in a tertiary care centre received a pelvic floor health workshop intervention versus routine prenatal care. Thirty-six participants/group were needed to detect a significant knowledge difference (power = 0.80, α = 0.05). Participants completed questionnaires at recruitment and six weeks postpartum. Main outcome measures were: difference between groups in knowledge scores; PFME-specific knowledge and practice; pelvic symptoms and condition-specific quality of life; and mode of and satisfaction with delivery.

RESULTS

Fifty women were recruited per group; 40 attended the workshop. Women were Caucasian (72%), college educated (96%), mean age 33.2. Mean demographics did not differ. Postpartum data were available for 37 women per group. The intervention group scored higher on a pelvic floor knowledge questionnaire (mean score 31.2/39 vs. 29.3/39, P = 0.02, 95% CI 0.3, 3.6). 58.3% of intervention participants reported daily performance of PFME compared with 22.9% of controls (P = 0.002) and rated higher confidence in correct performance (P = 0.004). The intervention group reported fewer bowel symptoms (P = 0.046). There were no differences in urinary or prolapse symptoms, mode of delivery, complications, or satisfaction.

CONCLUSION

A pelvic floor health workshop improves postpartum knowledge, performance of PFME, and bowel-specific quality of life.

Comprehension of Pelvic Organ Prolapse and Urinary Incontinence in Southern Appalachian Women

OBJECTIVES

Despite their growing prevalence, pelvic floor disorders (PFDs) remain undertreated and not well understood by patients, with treatment disparities noted in specific subgroups of women. The goal of the present study was to determine the basic understanding of PFDs of women in the southern Appalachian region of the United States, to determine factors that predict knowledge, and to explore the possible disparities in seeking access to care among women in this region who reported symptoms.

METHODS

A survey of patient knowledge of PFDs, specifically urinary incontinence (UI) and pelvic organ prolapse (POP), was conducted in Johnson City, Tennessee, and involved 305 female patients from this city and the surrounding region.

RESULTS

Almost half of the participants (43%) reported UI symptoms, with only 25% of these participants reporting treatment. A much smaller percentage (5%) reported POP symptoms, but 44% reported receiving treatment. Overall proficiency for UI knowledge was 54.4%, and 69.5% for POP knowledge. Higher UI knowledge was predicted (P < 0.05) by age younger than 60 years, annual income >$50,000, more than a high school education, and being married. UI knowledge was unrelated to the presence of UI symptoms, receipt of UI treatment, or having seen a urospecialist. Higher POP knowledge was predicted (P < 0.05) by annual income >$50,000, more than a high school education, and presence of POP symptoms. The only factor significantly predicting seeking treatment among women with UI symptoms was marital status.

CONCLUSIONS

Overall knowledge of both UI and POP was reasonably high in this population, suggesting appropriate self-education or education by providers in the region. The women most affected by UI, particularly those older than 60 years, were not well informed, and education by providers does not appear to specifically target women seeking treatment. We must continue to educate and further reduce the gap of knowledge and treatment regarding PFDs in southern Appalachia.

Reliability and validity of the Incontinence Quiz-Turkish version

AIM

The aim of this study was to investigate the reliability and validity of the Turkish version of the Incontinence Quiz, which was developed by Branch et al. (1994), to assess women's knowledge of and attitudes toward urinary incontinence.

METHODS

Comprehensibility of the Turkish version of the 14-item Incontinence Quiz, which was prepared following translation-back translation procedures, was tested on a pilot group of eight women, and its internal reliability, test-retest reliability and construct validity were assessed in 150 women who attended the gynecology clinics of three hospitals in İçel, Turkey. Physical and sociodemographic characteristics and presence of incontinence complaints were also recorded. Data were analyzed at the 0.05 alpha level, using SPSS version 22.

RESULTS

The scale had good reliability and validity. The internal reliability coefficient (Cronbach α) was 0.80, test-retest correlation coefficients were 0.83-0.94; and with regard to construct validity, Kaiser-Meyer-Olkin coefficient was 0.76 and Barlett sphericity test was 562.777 (P = 0.000). Turkish version of the Incontinence Quiz had a four-factor structure, with Eigenvalues ranging from 1.17 to 4.08.

CONCLUSIONS

The Incontinence Quiz-Turkish version is a highly comprehensible, reliable and valid scale, which may be used to assess Turkish-speaking women's knowledge of and attitudes toward urinary incontinence.