Does prolapse and incontinence knowledge change after a visit with a Urogynecology provider?

Objectives: The Prolapse and Incontinence Knowledge Questionnaire (PIKQ) measures patient knowledge related to prolapse and incontinence. The primary objective of this study was to measure change in PIKQ scores before versus after a new patient visit with a Urogynecology provider. Secondary objectives were to explore correlations between PIKQ knowledge change, pelvic anatomy knowledge, health literacy, and decision satisfaction.

Methods: English and Spanish-speaking new patients, age > 18, referred to a Urogynecology practice for urinary leakage or pelvic organ prolapse were included in this cross-sectional study. Patients consented and self-reported demographic information prior to completing a multiple choice diagram of pelvic anatomy and the following validated instruments: 1) the PIKQ, 2) Short Assessment of Health Literacy, and 3) Satisfaction with Decision Scale for Pelvic Floor Disorders. The PIKQ is scored on a scale of 0-24, with higher scores indicating more knowledge. Assuming a mean score of 15 +/- 6 (α 0.05, β 0.20, 5% missing data) a final sample size of 95 was needed to detect a moderate effect size (0.3) for change in knowledge after exposure to a new patient visit. Knowledge levels pre- and post-visit were compared, and factors associated with knowledge change were assessed using t-tests, Pearson correlation coefficients, and regression models.

Results: Ninety-four patients had complete data, 5/94 (5%) of which were Spanish-speaking. Mean age was 56 +/- 13.5 years, with the most common diagnoses being overactive bladder (60/94, 64%), stress urinary incontinence (57/94, 61%), and pelvic organ prolapse (36/94, 38%). Mean PIKQ score prior to the visit was 15.8 +/- 6.2, and scores significantly increased after the new patient visit (2.4 +/- 5.2 points, p< 0.001). There was no change in pelvic anatomy knowledge scores (0.04 +/- 1.9 points, p=0.83). Health literacy scores were high (mean 17.5 out of 18, +/- 0.8), with one patient meeting criteria for “low health literacy.” Satisfaction with decisions was similarly high, with only 2/94 (2%) patients reporting decision dissatisfaction. Changes in PIKQ scores did not correlate with decision satisfaction (correlation coefficient -0.07, p=0.52). Pre-visit PIKQ scores were correlated with pre-visit pelvic anatomy knowledge (correlation coefficient 0.23, p=0.02). However, a change in PIKQ score was not correlated with a change in anatomy knowledge (correlation coefficient 0.15, p=0.15).

Conclusions: Prolapse and incontinence knowledge increased after new patient visits, though changes were not correlated with decision satisfaction. The health literacy level was high in this study population, which limited our ability to assess associations.