Systematic Review: Quantitative Studies on Barriers to Urogynecology Care in Minoritized Women

Objectives: Studies have confirmed that racial/ethnic minority women suffering with pelvic floor disorders endure disparate care. In our previous work, we found there was scarcity in research focused on identifying barriers to urogynecologic care using qualitative research methodology. We sought to summarize studies using quantitative research methodologies that assessed barriers to urogynecologic care (including care for symptoms and diagnoses of accidental bowel leakage (ABL), pelvic organ prolapse (POP), and urinary incontinence (UI)) for racial/ethnic minority women in the United States.

Methods: We completed a systematic review per PRISMA guidelines for studies using the following inclusion criteria: 1) studies examining barriers to care for persons with urogynecologic symptoms/diagnoses, 2) cohorts with persons experiencing urogynecologic symptoms and/or diagnoses, 3) cohorts inclusive of racial/ethnic minority persons, 4) studies utilizing quantitative research methodologies, 5) studies published in the year 2000 and later. Exclusion criteria included the following: 1) study cohorts inclusive of populations outside of the US, without racial/ethnic minority persons, or children; 2) studies utilizing qualitative research methodologies solely. We searched (performed 11/2/2021) for studies using the following electronic bibliographic databases: CINAHL Complete, Cochrane Library, PubMed, SCOPUS, Web of Science. We also queried Google Scholar and the Grey Literature. Two independent reviewers completed data abstraction from full-text manuscripts that met criteria. A third reviewer adjudicated all discrepancies. Study characteristics, methodology and details regarding findings related to barriers to urogynecologic care were reported using a thematic synthesis approach.

Results: There were 360 studies identified through the systematic search. Twenty-seven studies met criteria for analysis: 15 had study populations with UI, 9 with any/multiple pelvic floor disorders (PFD), 2 with POP, and 1 with any urologic symptoms. Most studies were cross-sectional analyses utilizing surveys or validated questionnaires for data collection (Table 1). There were 21 studies with Black/African-American subjects, 18 studies with Latina/Hispanic subjects, 11 studies with Asian subjects, and 5 studies with Native American subjects. Only 12 studies state primary research aims focused on evaluating barriers to urogynecologic care for racial/ethnic minority populations (Table 1). Barriers often focused on lack of knowledge and treatment seeking characteristics. For those studies with primary aims to examine barriers to care, validated questionnaires most often used included the Barriers to Incontinence Care Seeking Questionnaire (BICS-Q) and the Prolapse and Incontinence Knowledge Questionnaire (PIKQ). The remaining 15 studies focused on aims that evaluated outcomes of interest by race/ethnicity.

Conclusions: Quantitative research on barriers to urogynecologic care for minoritized groups has been limited and is often centered around patient knowledge and treatment-seeking behaviors. Interestingly, no studies identified how racism served as a barrier despite this being a known, but poorly measured contributor to health disparities. We are calling for research to go beyond identification of disparities and move into understanding and resolution.