Pelvic floor disorders (PFDs) pose unique challenges for women seeking care, and these challenges are even more pronounced for minority women [1]. Barriers to effective healthcare encompass several factors, including patient-provider relationships and lack of treatment awareness [2-3]. Patient-provider relationships play an especially pivotal role. Providers contribute to such barriers in various ways, including general miscommunication, sparse patient education, cultural ineptness, or lack of accessible resources. Few studies examine the influence of patient-provider relationships as a barrier to care to treatment of PFDs in ethnically diverse women in the United States. Moreover, limited understanding of PFD treatment options may inhibit treatment-seeking behavior. These barriers contribute to delayed diagnosis and treatment, if at all, that negatively impacts the overall health outcomes of minority women with PFDs [1-3]. To fill this important gap in the literature, we aimed to evaluate both patient perceptions of their provider relationships in their treatment for PFDs and their treatment awareness through qualitative analysis of focus groups consisting of minority women with PFDs. We hypothesize that these focus groups will groups shed light on an array of specific barriers that minority women face in accessing treatment, as shared through personal accounts.

Four semi-structured focus groups were conducted at our home institution. All focus groups involved Hispanic or African American women with diagnosed PFDs recruited from the urogynecology clinic in a group interview setting. Two focus groups were conducted in Spanish for Hispanic Spanish-speaking women (HS) (n=7), and two for Hispanic English-speaking (HE) (n=2) and African American English-speaking (AA) (n=4) women in English. Women were asked a series of questions regarding their PFD, care-seeking attitudes, and barriers to receiving treatment. These questions encompassed the topics of urinary incontinence, pelvic organ prolapse, genito-pelvic pain, and social determinants of health. Transcripts of focus groups were recorded, and a general inductive approach involving systematic independent analysis of themes was utilized by authors to examine patient perceptions of their provider relationships in their treatment for PFDs.

Key messages from five broad themes describing patient-provider relationship factors were derived from the group discussions (Table 1, Figure 1): (1) the majority of patients are comfortable discussing symptoms and treatments for PFDs with their providers;  (2) patients do not feel uncomfortable with a male provider, however they may prefer a female provider; (3) language does not serve to be a barrier due to the availability of Spanish-speaking providers and interpreters within the institution, but may be a barrier elsewhere; (4) increased availability of educational materials and more time spent explaining diagnoses and treatment would greatly improve perceived patient-provider relationship; (5) scheduling appointments with providers can be a barrier due to decreased provider availability and patients’ work hour requirements. 

Moreover, key messages from three broad themes related to treatment awareness were also derived from group discussions (Table 1, Figure 2): (1) the majority of patients were unaware of treatments for PFDs; (2) while there were different preferences for surgical versus medical treatment, participants were overwhelmingly interested in treatment overall; (3) most patients who underwent prior treatment reported success.

The collection of themes through our analyses revealed to us the need for greater investment in access for our patients, particularly those who are Spanish speaking. Gender, time spent on education and communication, and accessibility to health care visits may influence the care received by Hispanic and African American women seeking PFD care.

The barriers to care for minority women seeking treatment for PFDs are complex and multifaceted, encompassing patient awareness, provider-relationship related issues, and social determinants of health. Addressing these barriers requires a comprehensive approach that includes patient education, provider training, and system-level changes to improve access to care and treatment options. The utilization of patient focus groups is a powerful tool in breaking down these barriers, providing a platform for minority women to voice their concerns and contributing to the development of more inclusive and effective healthcare practices. Overall, the qualitative insights from our study enable a deeper understanding of the patient perspective, guiding the development of targeted interventions for minority women seeking care for PFDs. By actively and continuously listening to the narratives of minority women, providers can work towards dismantling the obstacles that hinder optimal and equitable care, ultimately promoting better health outcomes and increased patient satisfaction.

Yeguez AC, Yeguez CE, Smith AL. Lost in Translation: Misconceptions and Miscommunications Among Spanish-Speaking Latinas with Pelvic Floor Disorders. Urology. 2022;163:34-43. doi:10.1016/j.urology.2021.05.003
Fante JF, Silva TD, Mateus-Vasconcelos ECL, Ferreira CHJ, Brito LGO. Do Women have Adequate Knowledge about Pelvic Floor Dysfunctions? A Systematic Review. Rev Bras Ginecol Obstet. 2019;41(8):508-519. doi:10.1055/s-0039-1695002
Dunivan GC, Anger JT, Alas A, et al. Pelvic Organ Prolapse: A Disease of Silence and Shame. Female Pelvic Med Reconstr Surg. 2014;20(6):322-327. doi:10.1097/SPV.0000000000000077

Continence 12S (2024) 101619
DOI: 10.1016/j.cont.2024.101619