Barriers and Promotors to Health Service Utilization for Pelvic Floor Disorders in the United States: Systematic Review and Meta-analysis of Qualitative and Quantitative Studies. Issue 9 (30th September 2022)

• Record Type: Journal Article
• Authors: Mou, Tsung; Gonzalez, Javier; Gupta, Ankita; O'Shea, Michele; Thibault, Mary Duarte; Gray, Elizabeth L.; Beestrum, Molly; Brown, Oluwateniola; Cichowski, Sara
• Is Part Of: Urogynecology. Volume 28:Issue 9(2022)
• Page Start: 574
• Page End: 581
• Publication Date: 2022-09-30
• Subjects: pelvic floor -- health care disparity -- access to health care -- health services accessibility; Pelvis -- Diseases; Pelvis -- Surgery; Urogynecology; Urogynecologic surgery; 616.6
• DOI: 10.1097/SPV.0000000000001215
• Languages: English
• ISSNs: 2771-1897

Abstract

Abstract : Importance: We need a systematic approach to understanding health service utilization behavior in women with pelvic floor symptoms in the United States. Objectives: The aim of this study was to determine the prevalence of pelvic floor care utilization and identify its barriers and promotors using Andersen's model, which theorizes care-seeking behavior with individual care needs, resources, predispositions, and macrostructures. Design: This was a systematic search of studies on care-seeking patterns in women with symptomatic pelvic floor disorders, which included pelvic organ prolapse, lower urinary tract symptoms, and anal incontinence. We then performed meta-analyses with random-effects models and descriptive analysis to determine utilization rate and the impact of each identified determinant. Results: The pooled utilization rate was 37% (95% confidence interval [CI], 30%–45%). Determinants were identified across all domains except at the macrostructure level. For individual care needs, increased symptom severity or duration and a history of depression (odds ratio [OR], 1.27; 95% CI, 1.07–1.51) were associated with higher utilization. In the resources domain, having social support and established primary/secondary care were promotors, whereas higher income and employed status trended as barriers. Under predispositions, age ≥50 years (OR, 1.29; 95% CI, 1.05–1.60), and pelvic floor awareness were associated with utilization, whereas Asian (OR, 0.60; 95% CI, 0.51–0.72) and Black (OR, 0.77; 95% CI, 0.55–1.08) women as well as women experiencing fear, misinformation, or normalization of pelvic floor disorders had decreased utilization. Conclusions: This review identified a low utilization rate for pelvic floor care and revealed multilayered, actionable items affecting care-seeking behavior. It highlights the need for more inclusive and multifaceted approaches in future pelvic floor disparity research and equity interventions.