Beneath the Urologic Iceberg: A Qualitative Study

描述(由申请人提供)：使用“疾病冰山”的比喻(Last，1963；2001)是为了承认这样一个事实，即虽然很常见，但一些临床上重要的症状从未进入卫生保健系统进行有效的治疗。许多症状是：(A)被个人识别、提出治疗、诊断、治疗，并最终记录为病例。然而，其他症状是：(B)被识别、出现，但没有被诊断、治疗或计算；(C)一些症状被个人识别但没有出现(可能接受自我护理)；而另一些症状(D)没有被识别，从未出现、治疗或计算。基于波士顿地区社区卫生(BACH)调查(DK56842)的流行病学结果，这项定性研究旨在探索泌尿系统疾病的潜在领域，以了解按种族/民族、性别、年龄和SES在特定症状(尿失禁、下尿路症状和间质性膀胱炎/疼痛膀胱综合征)寻求帮助方面的报道差异。巴赫揭示了不同的社会文化群体是如何对这些泌尿系统症状做出反应的；这项互补性的定性研究旨在解释原因。巴赫科目(已经确定)将被随机选择来填写特定的设计单元格。经验丰富的研究人员将采用既定的定性技术，以获取与泌尿系统症状相关的价值观、信念、规范、归因、障碍和可感知的污名的信息。有几个特点是为了克服定性研究的局限性(代表性、外部效度和可复制性)。该项目具有很高的公共卫生意义：(1)对巴赫研究发现的“泌尿外科冰山”的深入研究很少；(2)它代表了一种针对健康差距这一新兴领域的实用和集中的方法；(3)它突出了报告的泌尿系统疾病发病率方面的缺陷(只有那些表现出来的才会被计算在内)；以及(4)更好地理解求助可以改善疾病的日常临床管理。

DESCRIPTION (provided by applicant): The metaphor of an "illness iceberg" (Last, 1963; 2001) is employed in recognition of the fact that, while common, some clinically important symptoms never make it to the health care system for effective treatment. Many symptoms are: (a) recognized by individuals, presented for treatment, diagnosed, treated and eventually recorded as a case. Others, however, are: (b) recognized, presented, but not diagnosed, treated, or counted; some symptoms are (c) recognized by individuals but not presented (possibly receiving self care); while others (d) are not recognized and never presented, treated or counted. Building on the epidemiologic findings from the Boston Area Community Health (BACH) survey (DK56842), this qualitative research is designed to explore the submerged areas of urologic disease, in order to understand reported disparities in help-seeking for a specific constellation of symptoms (Urinary Incontinence, Lower Urinary Tract Symptoms and Interstitial Cystitis/Painful Bladder Syndrome), by race/ethnicity, gender, age and SES. BACH is revealing how different sociocultural groups respond to these urologic symptoms; this complementary qualitative research is designed to explain why. BACH subjects (already identified) will be randomly selected to fill specific design cells. Established qualitative techniques will be employed by experienced investigators to elicit information on values, beliefs, norms, attributions, barriers and the perceived stigma associated with urologic symptoms. Several features are designed to overcome perceived limitations of qualitative research (representativeness, external validity and replicability). The project has high public health significance: (1) There are few in-depth studies of the "urologic iceberg" being uncovered by the BACH study; (2) It represents a practical and focused approach to an emerging area of health disparities; (3) It highlights a flaw in reported urologic disease rates (only those presenting get counted); and (4) Better understanding of help-seeking can improve the everyday clinical management of disease.