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Impact of Urinary Incontinence Education on Healthcare-Seeking Practices among Older Women in Nigeria

Abstract

Urinary incontinence is an important but often underrecognized health concern among older women and may affect physical wellbeing, emotional health, social participation, personal hygiene, sleep, and overall quality of life. Older women in Nigeria may experience urinary leakage associated with ageing, previous childbirth, pelvic-floor changes, menopause, chronic health conditions, medications, or other underlying factors. Despite its potential impact, some women may consider urinary incontinence an inevitable part of ageing or a condition that should be managed privately, which may discourage timely healthcare-seeking. Limited knowledge about available treatment options, embarrassment, stigma, financial barriers, limited access to appropriate healthcare services, and misconceptions about the causes of urinary incontinence may further contribute to delays in seeking professional care. Urinary incontinence education provides an opportunity to improve women's understanding of the condition, available management options, and the importance of professional assessment. Against this background, this study investigates the impact of urinary incontinence education on healthcare-seeking practices among older women in Nigeria. The study will be anchored on the Health Belief Model, Health Literacy Framework, and Social Ecological Model. The Health Belief Model explains how older women's perceptions of susceptibility to urinary incontinence, perceived severity, perceived benefits of seeking healthcare, perceived barriers, self-efficacy, and cues to action may influence healthcare-seeking practices. The Health Literacy Framework emphasizes women's ability to access, understand, evaluate, and apply reliable information about urinary incontinence and available healthcare services. The Social Ecological Model emphasizes the influence of individual, family, community, cultural, socioeconomic, and healthcare-system factors on healthcare-seeking for urinary symptoms. Collectively, these theoretical perspectives provide a suitable framework for explaining how urinary incontinence education may influence healthcare-seeking practices among older women in Nigeria. The study will adopt a quantitative quasi-experimental or analytical cross-sectional research design. The study population will comprise women aged 60 years and above residing in selected urban and rural communities across Nigeria. A multistage sampling technique will be used to select geopolitical zones, states, local government areas, communities, households, primary healthcare facilities, and eligible older women. Urinary incontinence education will be assessed using indicators such as exposure to educational sessions, frequency and duration of education, information on urinary incontinence, possible causes and risk factors, different types of urinary incontinence, bladder-health practices, pelvic-floor muscle exercises, lifestyle considerations, available treatment options, medication and clinical management, when to seek professional care, available healthcare providers, referral pathways, and reliable sources of urinary-health information. Healthcare-seeking practices will be assessed using indicators such as seeking professional healthcare for urinary leakage, timing of healthcare-seeking after symptom onset, attendance at appropriate healthcare facilities, consultation with qualified healthcare providers, reporting urinary symptoms during routine medical visits, compliance with recommended investigations or treatment, follow-up attendance, and willingness to seek care for persistent or worsening symptoms. Data will be collected using structured questionnaires, standardized urinary-incontinence knowledge and healthcare-seeking assessment tools, healthcare records where ethically accessible, and pre-test and post-test assessments where a quasi-experimental intervention is adopted. Descriptive statistics will be used to summarize participants' demographic and socioeconomic characteristics, reproductive and health history, urinary symptoms, previous healthcare experiences, sources of health information, exposure to urinary-incontinence education, and healthcare-seeking patterns. Inferential statistical techniques, including chi-square tests, paired and independent t-tests, correlation analysis, and logistic or multiple regression analysis where appropriate, will be used to determine the impact of urinary incontinence education on healthcare-seeking practices. Where a quasi-experimental design is adopted, healthcare-seeking outcomes before and after the educational intervention may be compared with those of a comparison group to determine changes associated with the intervention. Diagnostic tests will also be conducted to assess the reliability, validity, and robustness of the findings. The study is expected to find that urinary incontinence education has a significant positive impact on healthcare-seeking practices among older women in Nigeria. Older women exposed to structured, evidence-based, culturally sensitive, and sustained education are expected to demonstrate greater willingness to seek professional healthcare for urinary incontinence than women without comparable education. Education may improve understanding of the fact that urinary incontinence is not necessarily an unavoidable consequence of ageing and may have treatable or manageable underlying causes. It may also improve women's knowledge of pelvic-floor exercises, appropriate lifestyle measures, available treatment options, and the importance of professional assessment for persistent or troublesome symptoms. Education may reduce embarrassment, stigma, and misconceptions that discourage women from discussing urinary symptoms with healthcare providers. However, cultural beliefs, embarrassment, fear of disclosure, financial constraints, geographical barriers, limited availability of appropriate services, inadequate geriatric and women's health services, and family attitudes may reduce the effectiveness of education alone. The study therefore expects accessible, confidential, practical, culturally appropriate, and sustained urinary-incontinence education, supported by responsive healthcare and referral services, to contribute significantly to improved healthcare-seeking practices among older women in Nigeria. The study is expected to contribute to the literature on urinary incontinence, older women's health, healthcare-seeking behaviour, women's health education, healthy ageing, pelvic-floor health, geriatric health, health literacy, quality of life, and public health in Nigeria. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, National Primary Health Care Development Agency, state ministries of health, primary healthcare centres, hospitals, geriatric services, women's health professionals, nurses, physiotherapists, physicians, community health workers, older-person organizations, development partners, and policymakers regarding strategies for improving recognition and management of urinary incontinence among older women. The study will also provide evidence-based recommendations for integrating urinary-incontinence education into primary healthcare and older-person health programmes, improving access to appropriate assessment and treatment services, strengthening pelvic-floor health education, reducing stigma surrounding urinary symptoms, improving referral and follow-up systems, and developing sustainable interventions that promote timely healthcare-seeking among older women across Nigeria.

Keywords: Urinary incontinence education, healthcare-seeking practices, older women, urinary incontinence, women's health, healthy ageing, pelvic-floor health, health education, health literacy, healthcare utilization, Nigeria, public health.