REDUCING DISPARITIES IN URINARY CONTROL SYMPTOMS FOR MINORITY WOMEN

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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.