REDUCING DISPARITIES IN URINARY CONTROL SYMPTOMS FOR MINORITY WOMEN

尿失禁和下尿路症状（UI/LUTS）是主要的医疗保健负担。不幸的是，在知识，获得治疗和纳入研究的少数民族妇女与UI/LUTS有很大的差距。一个重要的差距是缺乏循证的非手术治疗选择（例如，饮食和行为改变、体重减轻和物理治疗（PT））。少数群体妇女往往无法获得更安全，保守的干预措施，由于获得和保险覆盖面差。此外，UI/LUTS会导致焦虑和抑郁，我们的初步研究表明，这会加剧器质性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，本项目将评价针对特定文化、家庭、社区卫生工作者（CHW）支持的保守干预UI/LUTS的可行性和有效性。支持干预将包括自我管理的认知行为治疗（CBT），行为矫正和自我导向的物理治疗练习。我们建议调整我们的临床医生指导的CBT为UI/LUTS自我管理的CBT课程，辅以自我导向的PT和行为再培训和支持，从CHW。我们的干预将测试可行性，有效性，坚持性和可接受性的干预一样，这是在一个大型的，公共资助的医院在芝加哥。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，患者可以在家中随访8周以上，以改善UI/LUTS; 2）确定这种干预治疗UI/LUTS的有效性以及参与者对该计划的可接受性和依从性。我们假设支持治疗将显著改善UI/LUTS，并且患者完成治疗将是满意和可行的。

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.