Social Processes Informing Toileting Behavior Among Adolescent and Adult Women: Social Cognitive Theory as an Interpretative Lens

Abstract

Little is known about social processes shaping adolescent and adult women’s toileting behaviors. The “Study of Habits, Attitudes, Realities, and Experiences” (SHARE) examines adolescent and adult women’s experiences related to bladder health across the life course. Forty-four focus groups with 360 participants organized by six age groups were conducted across seven sites. A transdisciplinary team used social cognitive theory as an interpretive lens across a five-stage analysis. The act of observing was identified as the overarching social process informing women’s toileting behaviors in three ways: (a) observing others’ toileting behavior, (b) being aware that one’s own toileting behaviors are monitored by others, and (c) observing oneself relative to others. We found that underlying processes of toileting behaviors, seemingly private are, in fact, highly social. We suggest, given this social embeddedness that health promotion efforts should leverage interpersonal networks for “social norming” interventions and policies to promote healthy toileting behaviors.

A multisite focus group study of US adult women's beliefs and assumptions about bladder health and function

“…Our analysis reveals that women are concerned about the potential impact of toileting habits, such as holding and cleanliness, on bladder health. The literature documents that toileting practices, including delayed voiding and management of hygiene issues in shared bathrooms and public restrooms are on the minds of women 1,3,4 …”

“…Among the women in this study, there was agreement on the importance of healthy bladder habits even in the face of uncertainty about what constitutes appropriate bladder health practices. Women's knowledge, assumptions, and beliefs about bladder health, like many other health behaviors, often are based on personal experience, what they observe from family members, glean from their inner circle of acquaintances, and learn from the larger social discourse on bladder function 3 . In the absence of established educational programming, woman can lack certitude about the accuracy of the information guiding their bladder practices, which at best may mute their use of positive behaviors or, at worst, allow them to engage in harmful behaviors.…”

“…The literature documents that toileting practices, including delayed voiding and management of hygiene issues in shared bathrooms and public restrooms are on the minds of women. 1,3,4 Younger participants shared a belief in a relationship between sexual behavior and bladder health, with sexual intercourse being in the causal pathway for UTIs. This supposition appears to be grounded in women's lived experience and in anecdotal accounts from friends and family.…”

“…Women's knowledge, assumptions, and beliefs about bladder health, like many other health behaviors, often are based on personal experience, what they observe from family members, glean from their inner circle of acquaintances, and learn from the larger social discourse on bladder function. 3 In the absence of established educational programming, woman can lack certitude about the accuracy of the information guiding their bladder practices, which at best may mute their use of positive behaviors or, at worst, allow them to engage in harmful behaviors. However, as our research revealed, women believe that bladder function and health behaviors are interrelated with potential for bidirectional impact.…”

“…Qualitative research with adult women revealed that formal and informal social norms, 3 personal and situational context, and behavioral strategies 4 can be influential in shaping public or private toileting behaviors. Women's beliefs about the risks for lower urinary tract disorders often lack scientific evidence and are based on lay understandings that associate LUTS with social and behavioral factors of daily life, including consuming a lot of water, engaging in frequent sexual behavior, and experiencing too much psychosocial stress 5 …”