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Impact of Urinary Incontinence Screening on Early Detection among Women Attending Primary Healthcare Centres in Nigeria

Abstract

Urinary incontinence is an important women's health concern that can affect physical health, psychological wellbeing, social participation, personal hygiene, and quality of life. Women may experience urinary incontinence in relation to pregnancy and childbirth, pelvic-floor dysfunction, ageing, menopause, obesity, chronic medical conditions, urinary tract problems, and other factors. Despite its potential impact, urinary incontinence may remain undetected because women may consider symptoms a normal consequence of ageing or childbirth, feel embarrassed discussing bladder problems, fear stigma, or lack awareness of available healthcare services. Routine urinary incontinence screening at primary healthcare centres provides an opportunity to identify women experiencing urinary symptoms and facilitate appropriate assessment, counselling, treatment, referral, and follow-up. Against this background, this study investigates the impact of urinary incontinence screening on early detection among women attending primary healthcare centres in Nigeria. The study will be anchored on the Health Belief Model, Andersen's Behavioral Model of Health Services Use, and the Social Ecological Model. The Health Belief Model explains how women's perceptions of susceptibility to urinary incontinence, perceived severity, perceived benefits of screening, perceived barriers, and cues to action may influence participation in urinary incontinence screening. Andersen's Behavioral Model explains how predisposing characteristics, enabling resources, and healthcare needs influence women's utilization of primary healthcare services and screening. The Social Ecological Model emphasizes the interaction between individual, interpersonal, organizational, community, and broader societal factors in determining access to and utilization of urinary health services. Collectively, these theoretical perspectives provide a suitable framework for explaining how urinary incontinence screening may influence early detection among women attending primary healthcare centres in Nigeria. The study will adopt a quantitative analytical cross-sectional or quasi-experimental research design. The study population will comprise adult women attending selected public and private primary healthcare centres across Nigeria. A multistage sampling technique will be used to select states, local government areas, communities, primary healthcare centres, and eligible women. Urinary incontinence screening will be assessed using indicators such as availability of routine screening, screening frequency, use of standardized screening questions or validated screening tools, healthcare-worker participation, privacy during screening, health education, screening coverage, referral arrangements, and follow-up procedures. Early detection will be assessed using indicators such as identification of urinary incontinence symptoms, identification of previously unreported cases, classification of urinary incontinence symptoms where clinically appropriate, duration between symptom onset and detection, clinical assessment following a positive screen, referral for further evaluation, and initiation of appropriate management or follow-up. Data will be collected using structured questionnaires, urinary incontinence screening tools, primary healthcare records, screening registers, referral records, and relevant programme documents. Descriptive statistics will be used to summarize participants' characteristics, screening coverage, urinary symptoms, and patterns of early detection. Inferential statistical techniques, including chi-square tests, t-tests, correlation analysis, and logistic or multiple regression analysis where appropriate, will be used to determine the impact of urinary incontinence screening on early detection. Where a quasi-experimental design is adopted, detection rates before and after implementation of routine screening may be compared, while relevant demographic, reproductive, obstetric, health, and healthcare-access factors are appropriately controlled. 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 screening has a significant positive impact on early detection among women attending primary healthcare centres in Nigeria. Women who participate in routine urinary incontinence screening are expected to have a higher likelihood of previously unrecognized urinary symptoms being identified than women without access to routine screening. Systematic screening may encourage women to discuss bladder symptoms that they might otherwise conceal because of embarrassment, stigma, or the belief that urinary leakage is a normal part of ageing or motherhood. Early identification may facilitate appropriate clinical assessment, pelvic-floor rehabilitation, lifestyle counselling, medical management, and referral to relevant specialists when necessary. Screening within primary healthcare centres may also improve accessibility and reduce the need for women to seek specialized care before symptoms are recognized. However, limited awareness, stigma, inadequate privacy, shortage of trained healthcare personnel, insufficient screening tools, heavy workloads, and weak referral and follow-up systems may reduce the effectiveness of screening programmes. The study therefore expects accessible, confidential, systematic, and appropriately implemented urinary incontinence screening to contribute significantly to improved early detection among women in Nigeria. The study is expected to contribute to the literature on urinary incontinence screening, early detection, women's health, pelvic-floor health, primary healthcare, preventive healthcare, reproductive health, healthy ageing, 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, healthcare providers, nurses, midwives, physiotherapists, community health workers, women's health programmes, development partners, and policymakers regarding strategies for improving the identification and management of urinary incontinence. The study will also provide evidence-based recommendations for integrating urinary incontinence screening into appropriate primary healthcare services, training healthcare workers in symptom identification and referral, improving privacy and confidentiality during screening, strengthening referral and follow-up systems, increasing awareness of urinary incontinence among women, and promoting early access to appropriate care across Nigeria.

Keywords: Urinary incontinence screening, early detection, urinary incontinence, women, primary healthcare centres, pelvic-floor health, women's health, preventive healthcare, healthcare utilization, Nigeria, public health.