REDUCING DISPARITIES IN URINARY CONTROL SYMPTOMS FOR MINORITY WOMEN

尿失禁和下尿路症状（UI/LUTS）是一个主要的医疗负担。不幸的是，在知识、获得治疗的机会和纳入研究方面，患有尿失联/尿失联的少数民族妇女存在很大差距。一个重要的差距是缺乏以证据为基础的非手术治疗选择（例如，饮食和行为改变、减肥和物理治疗）。少数族裔妇女往往无法获得更安全、更保守的干预措施，因为她们的渠道和保险覆盖面都很差。此外，UI/LUTS导致焦虑和抑郁，我们的初步研究表明，这加剧了有机UI/LUTS症状。鉴于获得PT的障碍以及对UI/LUTS的行为和心理健康影响，本项目将评估针对UI/LUTS的文化特定、基于家庭、社区卫生工作者（CHW）支持的保守干预措施的可行性和有效性。支持干预将包括自我管理认知行为疗法（CBT），行为修改和自我指导的物理治疗练习。我们建议将临床指导的UI/LUTS CBT调整为自我管理的CBT课程，辅以自我指导的PT和行为再培训以及CHW的支持。我们的干预将在芝加哥的一家大型公立医院测试这种干预的可行性，有效性，依从性和可接受性。在4年的时间里，我们的目标是：1)编写一本家庭CBT和PT手册，该手册对患者文化和健康素养敏感，并且可以在家中随访患者超过8周，以改善UI/LUTS；2)确定该干预措施在治疗UI/LUTS中的有效性，以及参与者对该计划的接受度和依从性。我们假设支持治疗将显著改善UI/LUTS，并且患者将满意和可行地完成。

Urinary incontinence and lower urinary tract symptoms (UI/LUTS) are a major healthcare burden. Unfortunately, there are large disparities in knowledge, access to treatment and inclusion in research for minority women with UI/LUTS. One important disparity is the lack of access to evidence-based, non-surgical treatment options (e.g., diet and behavioral modification, weight loss and physical therapy (PT)). Minority women often to not have access to safer, conservative interventions due to poor access and insurance coverage. Additionally, UI/LUTS lead to anxiety and depression, which our preliminary studies have shown, exacerbate organic UI/LUTS symptoms. Given the barriers to accessing PT and the behavioral and mental health impacts on UI/LUTS, this project will evaluate the feasibility and efficacy of a culturally-specific, home- based, community health-worker (CHW) supported, conservative intervention for UI/LUTS. The SUPPORT intervention will include self-managed cognitive behavioral therapy (CBT), behavioral modifications and self-directed physical therapy exercises. We propose to adapt our clinician-guided CBT for UI/LUTS to a self-managed CBT curriculum supplemented with self-directed PT and behavioral retraining and support from a CHW. Our intervention will test the feasibility, efficacy, adherence and acceptability of an intervention like this is in a large, publicly funded hospital in Chicago. Over 4 years, we aim to 1) write a home CBT and PT handbook that is sensitive to patient culture and health literacy and can be followed by the patient at home over 8 weeks to improve UI/LUTS; 2) to determine the efficacy of this intervention in treating UI/LUTS and the acceptability and adherence to this program of our participants. We hypothesize that SUPPORT therapy will significantly improve UI/LUTS and will be satisfying and feasible for patients to complete.