Beneath the Urologic Iceberg: A Qualitative Study

描述（由申请人提供）：采用“疾病冰山”的比喻（Last，1963; 2001）来认识到这样一个事实，即尽管常见，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，其他的是：（B）识别、出现但未诊断、治疗或计数;某些症状（c）被个体识别但未出现（可能接受自我护理）;而其他症状（d）未被识别且从未出现、治疗或计数。基于波士顿地区社区健康（BACH）调查（DK 56842）的流行病学结果，本定性研究旨在探索泌尿系统疾病的淹没区域，以了解种族/种族、性别、年龄和SES在寻求特定症状（尿失禁、下尿路症状和间质性膀胱炎/膀胱疼痛综合征）帮助方面的差异。BACH揭示了不同的社会文化群体对这些泌尿系统症状的反应;这项补充性定性研究旨在解释原因。将随机选择BACH受试者（已确定）填写特定设计单元格。经验丰富的研究者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、障碍和感知耻辱的信息。几个功能的目的是克服定性研究（代表性，外部有效性和可复制性）的感知局限性。该项目具有很高的公共卫生意义：（1）BACH研究所揭示的“泌尿系冰山”的深入研究很少;（2）它代表了一种针对健康差异新领域的实用和重点方法;（3）它突出了报告的泌尿系疾病率的缺陷（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.