U.S. Adolescent and Adult Women’s Experiences Accessing and Using Toilets in Schools, Workplaces, and Public Spaces: A Multi-Site Focus Group Study to Inform Future Research in Bladder Health

Abstract

The World Health Organization recognizes access to clean and safe toilets as crucial for public health. This study explored U.S. adolescent and adult cisgender women’s lived experiences accessing toilets in schools, workplaces, and public spaces. As part of the Prevention of Lower Urinary Tract Symptoms (PLUS) Research Consortium, we conducted 44 focus groups with female participants (n = 360; ages 11–93). Focus groups were stratified by age (11–14, 15–17, 18–25, 26–44, 45–64, 65+) and conducted across 7 geographically diverse U.S. sites from July 2017–April 2018. Using a transdisciplinary approach, we conducted conventional qualitative coding informed by our PLUS conceptual framework and used content analysis processes to identify salient themes. Across settings, toilet access was restricted by “gatekeepers” (i.e., individuals who control access to toilets). In contrast, self-restricting toilet use (deciding not to use the toilet despite biologic need to urinate) was based on internalized norms to prioritize school and job responsibilities over urination. In public spaces, self-restricting use was largely in response to lack of cleanliness. Across the life course, participants perceived gender disparities in the ability to easily access public toilets. Further research is needed to determine if and how these factors impact bladder health across the life course.

The impact of COVID-19 on surgical training: a systematic review

“…Only 1 of our studies compared degree of stress by sex, amongst French urology trainees sex was not associated with increased stress during the pandemic [ 37 ]. Surgical trainees across all specialities are already known to have high rates of burnout [ 48 , 49 ], therefore it is important that trainees are given adequate support not only during but also after the pandemic.…”

Is the juice worth the squeeze? Transdisciplinary team science in bladder health

“…PLUS investigators recognized the need for upfront time to develop a positive transdisciplinary culture, and that this would likely delay short‐term productivity when judged by traditional metrics (eg, publications, presentations, and abstracts at national meetings). These short‐term delays have already been offset by progress with conceptual work and research that promises a significant health impact, including 11 peer‐reviewed papers, 1,9,10,15‐22 26 peer‐reviewed abstracts, 23‐47 and 15 invited presentations to date. PLUS has formalized key strategic initiatives informed by the shared language, critical awareness, and transdisciplinary orientation developed over the past 4 years.…”

“…There is evidence that the PLUS Consortium is maturing as a transdisciplinary team. Products include a strong conceptual framework, 10 a clear working definition of bladder health, 9 insights from the PLUS consortium qualitative study, 15‐17,26 completed literature reviews, 21 development of items to measure bladder health and protocols to validate the instrument (not yet published), submitted and planned manuscripts, completed academic presentations, ongoing foundational studies, and a solidified commitment to community engagement.…”

“…Ongoing dialog and educational sessions prepared PLUS members to seek community input on our investigator‐proposed measure of bladder health. Input from community stakeholders ensured that our definition of bladder health was grounded in lived experience and was instrumental in shaping our initial project, a qualitative research study to explore experiences of women and girls with regard to bladder health and LUTS 15‐18 . PLUS members with and without prior community engagement experience developed a Community Engagement Practices and Procedures manual to develop a shared language for PLUS members to use in all future research endeavors.…”

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

“…Recent efforts to promote bladder health and prevent LUTS reveal a role for qualitative research to identify the underlying social processes shaping lay women's assumptions and practices related to bladder health and function (Low et al, 2019). In particular, the identification of the social processes underlying toileting behaviors, such as norms regulating bathroom use (Camenga et al, 2019), can inform our understanding of risk or protective factors for bladder health. Social processes underlying toileting behaviors, and social norms including frequency of visiting the bathroom to void (empty one's bladder), voiding position, and duration in the bathroom, may in fact be risk or protective factors for bladder health.…”