Urinary incontinence (UI) is a very debilitating condition, affecting quality of life of millions of women worldwide. International organisations and systematic reviews has recommended pelvic floor muscle training as an effective first-line of conservative management for UI.(1) Studies have revealed multiple possible reasons for women not accessing medical help.(2) Health promotion and awareness programs have helped in reducing the burden and improving access to health care services by improving awareness among women and health care professionals. This study was therefore undertaken with the aim to evaluate if an awareness program among health care professionals will improve the number of women accessing physiotherapy services for management of UI.

Pre-post Experimental design was used to conduct the study in which a proposal was planned following ethical approval from the ethics committee of a medical college. A three month awareness program was delivered using a health systems approach. Since the study used health system research and  included health care professionals as participants, a-priori sample size estimation was not done. Awareness program in the form of five interactive session was delivered to the faculty, postgraduate students and clinicians in the departments of Obstetrics and Gynaecology and Physiotherapy. The program targeted improving knowledge and awareness about the burden of the health condition and treatment guidelines.
In addition, potential of referral of women with UI for physiotherapy interventions was calculated for three months using hospital new registration data and qualitative analysis was done among key stakeholders as a follow up.

Total 51 participants received five sessions of awareness program. Post intervention the change in the number of women receiving management for UI was calculated from department register and billing codes. There was no difference seen in the trend of referrals and the number of women receiving physiotherapy services for UI pre and post awareness program. 
Calculation for estimating potential of referral indicated that during the three-month period, a total of 26546, 5371 and 271 adult women (36±21 years) visited out-patient departments of all departments, high potential departments and physiotherapy department respectively. If there existed a clinical care pathway to screen for UI among all adult women visiting the hospital; even at a conservative estimate of 25% prevalence and screening of 50% women, about 5309, 1074 and 54 women from all departments, high potential departments and physiotherapy department respectively could have been identified with incontinence and referred to physiotherapy department as compared to receiving one per month.

Awareness program did not improve awareness among key stakeholders as the number of women referred for physiotherapy interventions for UI remain unchanged. Analysis for the estimation of potential of referral and comparison indicated that there is a huge gap between the current referral pattern (one referral / month) and the potential for referrals.

There is a huge potential of referrals to physiotherapy services for urinary incontinence among women. Awareness program did not bring the desired result among key stakeholders due to existence of multiple barriers which needs integrated health approach which targets stakeholder and women for reducing burden of a disease and uplifting health care delivery system.

Abrams P, Andersson K, Apostolidis A, Birder L, Bliss D, Brubaker L et al. 6th International Consultation on Incontinence. Recommendations of the International Scientific Committee: Evaluation And Treatment Of Urinary Incontinence, Pelvic Organ Prolapse And Faecal Incontinence. Neurourology and Urodynamics. 2018;37(7):2271-2272.
Waetjen L, Xing G, Johnson W, Melnikow J, Gold E. Factors associated with reasons incontinent midlife women report for not seeking urinary incontinence treatment over 9 years across the menopausal transition. Menopause. 2018;25(1): 29-37.

Continence 2S2 (2022) 100475
DOI: 10.1016/j.cont.2022.100475