Knowledge of Pelvic Floor Disorders Among Spanish and English Speakers at a Federally Qualified Women's Health Clinic

INTRODUCTION: Among the general population, baseline knowledge of pelvic floor disorders (PFDs) is low. Comparisons of this knowledge between Spanish and English speakers in underserved communities have not been well-explored. This information is crucial for targeting PFD interventions to improve health equity in underserved populations. OBJECTIVE: This study aims to assess the baseline knowledge of PFDs among low-income, predominantly Latina and African American patients at a federally qualified health center (FQHC). We sought to compare knowledge by primary language (English vs. Spanish) and other demographic factors. METHODS: This cross-sectional survey investigation utilized the Prolapse and Incontinence Knowledge Questionnaire (PIKQ) to evaluate baseline patient knowledge in their preferred language. Demographic characteristics were also collected. Participants included individuals visiting a women’s health FQHC between February 1, 2023, and May 1, 2023, who were at least 18 years old, English- or Spanish-speaking, and provided verbal consent for a telephone survey. Univariate analyses were performed on participant characteristics as well as a multivariate regression model with interaction of income and education. RESULTS: A total of 153 patients were contacted, with 43 excluded for declining or non-responsiveness after two calls. Of the 110 respondents, 34% identified as African American and 61% as Latina, with the remainder Asian, Middle Eastern, or White. Forty-six participants reported English as their primary language, while 64 spoke Spanish. Most patients (45%) had an annual income between $20,000 and $34,999, and 39% earned less than $20,000. Over three-quarters (77%) had a high school education or less, and 53% were unemployed. The mean parity was 2.8, with a median of 2 vaginal deliveries. Most respondents denied issues with urinary incontinence (UI) (77%) or pelvic organ prolapse (POP) (79%), and 85% did not know anyone with these conditions. The overall mean PIKQ score was 53.6%. PIKQ-POP scores were similar between Latina and African American patients (48% vs. 49%), and PIKQ-UI scores were also comparable (53% vs. 55%). Women with UI had a mean PIKQ-UI score of 63% compared to 51% for those without, while those with POP scored 66% versus 47% for those without. Respondents who knew someone with UI or POP had higher mean scores (53% vs. 48% for PIKQ-POP and 57% vs. 53% for PIKQ-UI). Regression analysis indicated no significant demographic factors impacted the PIKQ-UI score. However, having a high school degree and an income between $20,000 and $49,999 were linked to lower PIKQ-UI scores (p=0.032). No significant demographic effects were found for PIKQ-POP scores. The Wilcoxon rank-sum test showed no difference in total scores between English and Spanish speakers. Having an associate’s degree increased the PIKQ score by 25.7% at the 90% confidence interval. CONCLUSIONS: Baseline knowledge of PFDs in our under-resourced cohort was not affected by language. Patients exposed to POP or UI through personal experience or others had higher baseline knowledge. While no single demographic characteristic led to decreased PIKQ scores, having a high school degree and income between $20,000 and $49,999 contributed to lower scores, whereas having an associate’s degree may contribute to higher scores (Tables 1 and 2).