Development and initial validation of a pictorial survey to assess for symptomatic pelvic organ prolapse and urinary incontinence in western Kenya.

Journal Article (Journal Article)

INTRODUCTION AND HYPOTHESIS: Visual tools are a valuable tool for ascertaining patient symptoms, especially in populations with low literacy rates. The objective was to develop and validate a pictorial scale for assessing symptomatic pelvic organ prolapse (POP) and urinary incontinence among women in western Kenya. METHODS: Illustrations of POP, stress urinary incontinence (SUI), and urgency urinary incontinence (UUI) were developed by an artist. Virtual Zoom interviews were conducted with gynecology providers in Kisumu soliciting feedback on the illustrations. Cognitive interviews with patients were then conducted. Validation of the illustrations was performed against the gold standard of clinical history and examination amongst patients presenting for outpatient care at three Kisumu hospitals. RESULTS: Sixteen provider interviews were conducted. The illustrations were revised to reflect each disorder more clearly, and performed well during cognitive interviews with 8 patients (aged 21 to 76). One hundred patients were included in the validation study. Nine patients had symptomatic POP, whereas 32 had UUI and 25 had SUI. Sensitivity and specificity for the SUI illustration was 80% (95% CI 61-91%) and 97% (95% CI 72-98%) and for UUI they were 81% (95% CI 65-91%) and 99% (95% CI 92-100%) respectively. POP illustrations had lower sensitivity and specificity, with the best performing illustration having sensitivity of 67% (95% CI 35-88%) and specificity of 99% (95% CI 94-100%), which improved when only bulge or pressure symptoms were included. CONCLUSIONS: We present a newly developed pictorial scale to assess for clinical urinary incontinence and POP that may be adapted and evaluated in other settings for clinical and research purposes.

Full Text

Duke Authors

Cited Authors

  • O'Shea, M; Omoto, J; Huchko, M; Gwer, S

Published Date

  • September 2022

Published In

Volume / Issue

  • 33 / 9

Start / End Page

  • 2515 - 2523

PubMed ID

  • 35773529

Pubmed Central ID

  • PMC9245869

Electronic International Standard Serial Number (EISSN)

  • 1433-3023

Digital Object Identifier (DOI)

  • 10.1007/s00192-022-05214-5


  • eng

Conference Location

  • England