# Turkish Adaptation and Psychometric Evaluation of the Barriers to Incontinence Care-Seeking Questionnaire

## TL;DR

This study adapts and validates a questionnaire to assess barriers to seeking care for urinary incontinence among Turkish women.

## Contribution

The Turkish version of the BICS-Q is validated for use in research and clinical settings in Turkey.

## Key findings

- The Turkish BICS-Q has high internal consistency (Cronbach's alpha = 0.846) and test–retest reliability (ICC = 0.854).
- Embarrassment, financial concerns, and low expectations from medical consultation are top barriers to care.
- The questionnaire is suitable for identifying healthcare inequalities and guiding policy improvements.

## Abstract

This study was aimed at adapting, validating, and assessing the reliability of the Turkish version of the "Barriers to Incontinence Care-Seeking Questionnaire" (BICS-Q).

One hundred and forty-eight Turkish women with mild to moderate urinary incontinence (UI) was assessed. The adaptation process was conducted in alignment with the COSMIN guidelines: forward–backward translation, expert review, cultural adaptation, and a pilot study. For construct validity, items from the study by El-Azab and Shaaban, which measure barriers to seeking care for incontinence, were adapted to this self-reported questionnaire (BICS-Q), and their associations with the total score as well as the subscale scores of the questionnaire were evaluated. Cronbach's alpha was used for internal consistency, and the intraclass correlation (ICC) coefficient was estimated for test–retest reliability.

The psychometric analyses indicated that the Turkish BICS-Q has high internal consistency (Cronbach's alpha = 0.846) and test–retest reliability (ICC = 0.854). Item analysis revealed that each item was significantly correlated with the total score, thereby confirming construct validity. It was also found that embarrassment, financial concerns, and low expectations from medical consultation were ranked as the most important barriers to treatment.

This study demonstrated the applicability of the Turkish BICS-Q for both research and clinical purposes, emphasizing its role in identifying health care inequalities and guiding policy improvements for women with UI. The present validation study provides evidence that the Turkish BICS-Q is an appropriate tool for assessing barriers to incontinence care seeking that can be used to further research and interventions toward overcoming the barriers in Turkey.