Socioeconomic differences in help-seeking intention for stress urinary incontinence: evidence from an...

Stress urinary incontinence is common among older women and can substantially affect quality of life, yet medical help-seeking remains low. While socioeconomic disparities have been associated with variations in health behavior, the underlying psychosocial pathways through which these disparities manifest are not well understood. This study aimed to identify psychosocial factors that influence intention to seek care for urinary incontinence and to assess whether they explain the association between socioeconomic status and help-seeking intention.

A cross-sectional survey was conducted among women aged ≥ 50 years with questionnaire-identified stress urinary incontinence recruited from 10 community health centers in Shanghai (N = 585). Measures were developed under the IMB model. Socioeconomic status was derived using latent class analysis. The primary outcome was intention to seek medical care within six months, assessed on a five-point scale. Ordered logistic regression models were used to examine associations and to evaluate attenuation of the socioeconomic effect after inclusion of model constructs.

Only 38.1% of participants reported high help-seeking intention (≥4 on a 1-5 scale). Subjective norms (cOR = 2.81, 95% CI 2.25-3.51) and stigma (cOR = 1.80, 95% CI 1.35-2.40) were the strongest correlates of higher intention, followed by patient-provider communication (cOR = 1.27, 95% CI 1.04-1.54). Knowledge was negatively associated with intention (cOR = 0.81, 95% CI 0.67-0.97). After sequentially adding information, motivational, and behavioral factors from the IMB framework, the association between socioeconomic status and help-seeking intention was attenuated by approximately 80% and was no longer statistically meaningful.

Social and psychological factors, particularly subjective norms, play a central role in shaping intention to seek care for stress urinary incontinence among older women. These factors substantially explain differences originally attributed to socioeconomic position. Interventions that shift community norms, reduce stigma, and strengthen communication in primary care may improve engagement with treatment and reduce unmet needs in aging populations.