Best Clinical Paper: Black and Latina Women’s Views on LUTS Treatment and a Home-based Intervention

Objectives: (1) To examine facilitators and barriers to treatment for lower urinary tract symptoms (LUTS) among care-seeking Black and Latina women and (2) to explore perspectives on SUPPORT, a self-directed, 8-week, home-based intervention combining education, bladder re-training, pelvic floor muscle training (PFMT) and cognitive behavior therapy (CBT).

Methods: This is an observational study using qualitative methodology. We recruited a convenience sample of care-seeking women with LUTS who self-identified as Black, African-American, or of Hispanic ethnicity and were English- or Spanish-speaking. Focus groups evaluated barriers and facilitators of available LUTS treatment and provided feedback on the SUPPORT intervention. Focus groups were conducted in the participants’ primary languages, audio-recorded, translated (Spanish), and transcribed. Two authors analyzed the transcripts using modified grounded theory techniques. Coders developed the codebook using deductive and inductive approaches. Codes were grouped into themes and subthemes, refined as necessary, and applied to transcribed text. Discrepancies were resolved through team discussion. Focus groups were conducted until thematic saturation.

Results: 27 women participated in seven focus groups (four in English, three in Spanish) between November 2022 and February 2023. There were 13 Non-Hispanic Black English speakers and 14 Hispanic participants (11 were Spanish Speakers). The mean ± SD age of the cohort was 49 ± 14 years. Most participants (75%) were publicly insured. None had undergone procedural treatment for LUTS, and the most common treatment discussed was standard PFMT. Shared barriers reported by both Black and Latina participants included (1) unfamiliarity with treatment options and negative perceptions of procedural treatments (2) unsatisfactory interactions with the health care team such as not being listened to, inability to contact physician, seeing multiple providers, (3) lengthy travel to obtain PFMT and transportation challenges (Table 1). Barriers distinct to Spanish-speaking participants included inadequate translator services and financial constraints. Barriers distinct to Black participants included feeling blocked from accessing care by support staff and limited insurance coverage. Participants reported these barriers disrupted care, hindered partnership, trust, and confidence in their providers, and created psychosocial distress (Figure 1). Facilitators of treatment included 1) patient-centered clinical environments characterized by supportive relationships with physicians and clinical staff, 2) streamlined financial assistance services, and 3) shared treatment decision-making. Most participants found the CBT component of the intervention concept promising for reducing psychosocial stress related to LUTS. They viewed the home-based approach positively due to the potential to overcome various barriers to treatment. Skeptical participants showed concern about the program’s efficacy for treating LUTS.

Conclusions: Participants reported individual, interpersonal, and structural barriers to LUTS treatments, especially standard physical therapy. The concept of a home-based PFMT + CBT was acceptable to participants and may overcome barriers to treatment. The data from this study will inform the design of our SUPPORT intervention.