Improving the assessment of women's health through the use of an electronic pelvic floor questionnaire

Background. Incontinence is an important women's health issue that can have devastating personal, occupational, social and economic consequences. However, the prevalence of urinary incontinence (UI) and fecal incontinence (FI) greatly outstrips detection and treatment.;Aim. To assess whether an electronic pelvic floor questionnaire (ePAQ-PF) can increase discussion rates of UI and FI in a primary care setting.;Methods. Women 40 and older presenting for a routine primary care physical were randomized to complete the e-PAQ-PF either prior to or after their visit. Discussion rates were evaluated through clinic note abstraction and participant report. Whether the clinician or patient initiated the conversation was also assessed. The factor structure, internal consistency reliability and construct validity of the ePAQ-PF was evaluated. Participants were also asked whether they had discussed incontinence with a clinician in the past and their reasons for not doing so.;Results. The factor structure of the ePAQ-PF was similar to that found previously. Most ePAQ-PF domains showed good internal consistency reliability and the ePAQ-PF appeared to have good construct validity. It had good acceptability among clinicians and participants. Administering the ePAQ-PF prior to the visit and giving the results to the clinician and participant increased reports of UI in the clinic note particularly in those women with UI and in older women. Clinicians were much more likely to initiate discussion of UI & FI in the pre-visit group. Fecal incontinence was rarely noted in the clinic note, but rates of FI discussion were increased in the pre-visit group per patient report. Women who reported not discussing UI and/or FI prior to their clinic visit most frequently indicated prioritization of other health problems, ability to self-manage symptoms, and belief that incontinence is a normal part of aging as reasons for non discussion. Embarrassment was not a major factor in non discussion.;Conclusion. The ePAQ-PF intervention was effective in increasing incontinence discussion rates. It may not fully address the issues of clinic visit time constraints and the way incontinence is prioritized in relation to other health problems. More research is needed to understand how to fully address these barriers to incontinence discussion.