Development of a psychosocial-clinical nomogram to predict delayed medical help-seeking in women with stress urinary incontinence: a retrospective cohort study

TL;DR

This study creates a tool to predict why women with urinary incontinence delay seeking medical help, combining clinical and psychological factors.

Contribution

A validated nomogram integrating psychosocial and clinical factors to predict delayed help-seeking in women with stress urinary incontinence.

Findings

58% of women with stress urinary incontinence delayed medical consultation for over six months.

The nomogram achieved strong discrimination (AUC = 0.855) and good calibration for predicting delayed help-seeking.

Psychological factors like anxiety and shame were significant predictors of delayed care.

Abstract

Delayed medical help-seeking is a common yet understudied behavior among women with stress urinary incontinence (SUI), potentially worsening symptom burden and diminishing quality of life. While clinical factors have been investigated, the contribution of psychosocial determinants remains poorly defined. This study aimed to identify key predictors and develop a validated nomogram for individualized risk estimation of delayed consultation.

In this retrospective cohort study, we analyzed electronic health records of 1,400 adult women diagnosed with SUI at a tertiary medical center in Southwest China (2019–2023). Delayed help-seeking was defined as > 6 months between symptom onset and first medical consultation. Multivariable logistic regression, guided by backward stepwise selection and Akaike Information Criterion, was used to identify independent predictors. A nomogram was constructed and internally validated using 1,000 bootstrap iterations. Model performance was evaluated by AUC, calibration curves, and Hosmer–Lemeshow test.

Delayed help-seeking occurred in 58.0% of patients. Independent risk factors included older age (aOR = 1.03), higher BMI (aOR = 1.06), SUI duration > 12 months (aOR = 3.14), severe symptom severity (aOR = 2.06), and initial consultation with urology rather than gynecology (aOR = 1.94). Psychological predictors such as elevated anxiety scores (aOR = 1.06), perceived shame (aOR = 1.47), and social avoidance behavior (aOR = 1.66) were significantly associated with delay, while higher education was protective (aOR = 0.36). The nomogram showed strong discrimination (AUC = 0.855) and good calibration.

Both clinical and psychosocial factors significantly influence delayed medical help-seeking in women with SUI. The proposed nomogram offers a validated, practical tool for early identification of high-risk individuals and may inform targeted interventions to reduce care delays and improve outcomes.

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