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

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 ≥50years (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.

Inequality in healthcare-seeking behavior among women with pelvic organ prolapse: a systematic review and narrative synthesis

“…Reproductive age and married women can get support and access to money compared to their counterparts. A systematic review and meta-analysis conducted on barriers and promoting factors to health service utilization for pelvic floor disorder in the United States showed that having social support and established primary/secondary care were facilitating factors for care seeking [ 66 ].…”

“…Two studies from eastern Ethiopia and Iran showed that a moderate wealth index and financial support improved health seeking behavior of women with pelvic floor disorders [ 68 , 69 ]. In addition, lack of awareness about the pelvic floor and experiencing fear were barriers to care-seeking [ 66 , 68 , 69 ]. A systematic review conducted in the United States showed that health service utilization for pelvic floor disorder was low among Black women [ 66 ].…”

“…In addition, lack of awareness about the pelvic floor and experiencing fear were barriers to care-seeking [ 66 , 68 , 69 ]. A systematic review conducted in the United States showed that health service utilization for pelvic floor disorder was low among Black women [ 66 ]. In low-income countries, even among women who seek health care, most of them were delayed for more than a year before seeking care.…”

Opportunities to Advance Postpartum Pelvic Floor Care With a Health Equity-based Conceptual Framework

“…2 A recent systematic review also found over 60% of women with symptomatic PFDs do not seek care, with even lower utilization rates among younger and minority women. 12 Strategies to address disparities in overall postpartum care have been studied including the use of patient navigators. 5,41 However, to our knowledge, there is no study to date that addresses or inquires about health disparities in postpartum pelvic floor care in the United State.…”

“…11 Several large studies have found significant inequities in rates of care utilization, surgical complications, medication prescription patterns, and the formation of clinical guidelines in historically marginalized populations. [12][13][14][15] However, the understanding of health disparities in postpartum PFD care remains understudied. This needs to be urgently and systematically examined, given the abundance of health disparities found in both postpartum and PFD care.…”