Understanding women’s attitudes to their experience of urine leakage and the use of absorbent textiles

Background: Urinary incontinence can be socially challenging for many women. It is often shrouded in secrecy due to social and cultural stigma. To overcome some of these challenges women may choose to use absorbent textile products as a coping strategy, to maintain social continence. Aim: This research aimed to take an integrated approach to exploring women’s attitudes towards their experience of urinary incontinence and the use or non-use of absorbent products, building on work by Getliffe et al. (2007). Methods: A scoping review was undertaken to identify how women use absorbent products. Experts-by-experience were then invited to join the study as members of a reference group, providing valuable insight throughout the research process. Socially acceptable terminology was used to recruit a convenience sample to two empirical studies. Qualitative semi-structured interviews were undertaken (n=11), which were thematically analysed. A sociotechnical analysis considered implications for absorbent product development. Interview data was used to develop a Q methodological study. Twenty women ranked statements by level of agreement, placing items onto a quasi-normal distribution grid. By-variable analysis generated factors which were interpreted to explain collective viewpoints between participants. Results: The scoping review identified that women used absorbent products, but that their use was affected by a number of considerations. The review highlighted that absorbent product use was challenging for women. Many of the concerns about urine leakage intersected with concerns about product use. This knowledge led to the development of the empirical studies. Three themes were identified in the interview study. ‘Maintaining identity’ considered the continuation of self and routine. Positive personal characteristics were prioritised by participants. ‘Communication’ was the second theme, highlighting the importance of verbal and non-verbal strategies to negotiate difficult situations. ‘Information and help-seeking’, influenced understanding and expectations for the future. The sociotechnical analysis suggested women would favour more personalised products, designed for the full product lifecycle. The Q study identified four distinct viewpoints. ‘Trial and error’ focussed on being proactive by dealing with urine leakage alone; ‘Carry on regardless’ provided a view of continuation in spite of urine leakage. ‘Shameful secret’ typified a lack of willingness to share information about experience due to the threat posed by leakage. ‘Wanting change’ considered leaking urine as normal ageing and viewed new products as a method to improve coping. Integration of both study findings revealed opportunities for improving care and products for women. Recognition of the social influences affecting help-seeking women requires further exploration. Conclusion: The findings of this novel study have clearly demonstrated differences in attitudes between women. In addition to highlighting a number of key issues which were important to all, such as the threat of stigmatisation, this study also explored diversity between women. This discernment supported characterisation of four viewpoints. It provided strong justification for personalisation of care. The benefits of understanding women’s attitudes are numerous. Attitudinal awareness can support healthcare practice and absorbent product development by facilitating more personalised provision.