Urinary incontinence management in Chinese primary health institutions: findings from a regional survey

Urinary incontinence (UI) is a prevalent yet under-recognized condition among women in China, impairing quality of life and imposing socioeconomic burden. Primary care providers are pivotal for early detection and first-line management. Unlike Western systems dominated by general practitioners, China' s primary women' s health care is largely provided by gynecologists in county-level or lower-tier institutions. Evidence on their UI-related knowledge and practices is limited, hampering targeted training and policy efforts.

We conducted a cross-sectional survey (March 2023-September 2024) among gynecologists in Fujian primary healthcare institutions recruited via professional WeChat groups. A structured, expert-developed questionnaire assessed demographics, UI-related awareness/perceptions (nine items, max score 18) and clinical practice (12 items, max score 24) on three-point Likert scales. Additional items explored barriers, preferred assessment methods, and factors influencing pelvic floor and bladder training. Reliability and construct validity were tested using Cronbach's α, KMO and Bartlett's tests. Multivariate linear regression identified factors associated with scores.

A total of 1,427 gynecologists responded (urban 75.5%; mean age 36.6 ± 9.3 years; 81.7% female). The questionnaire showed high reliability (α = 0.84) and good validity (KMO = 0.88; Bartlett's P < 0.001). Mean awareness/perception and clinical practice scores were 12.24 ± 3.07/18 and 12.63 ± 5.41/24. Only 20.3% routinely screened for UI symptoms and 10.5% felt confident managing UI. Female gender and higher education were associated with better awareness; older age and female gender were associated with better practice (all P < 0.05). Lack of UI training and infrequent literature reading correlated with lower scores. Urban physicians cited time constraints, whereas rural physicians cited limited space, lack of feedback mechanisms for exercises, and lower use of pelvic floor ultrasound or pad tests.

This first large-scale evaluation of UI-related knowledge and practice among Chinese primary care gynecologists reveals substantial gaps, especially in rural areas. Incorporating UI into continuing medical education, promoting routine screening, updating diagnostic knowledge, and applying digital tools for real-time monitoring of pelvic floor training may improve early detection and care. Tailored interventions addressing urban-rural disparities are essential to strengthen UI management at the primary care level.