LoginHow to identify and manage incontinence in culturally and linguistically diverse patients
It’s World Continence Week next week when the Continence Foundation of Australia launches its national campaign, Talk about incontinence: A problem in anyone’s language – with a special focus on the communication barriers and cultural misconceptions that prevent non-English speaking people from seeking help about incontinence. Incontinence is one of the least discussed health conditions. In fact, an estimated 70 per cent of people affected by incontinence don’t talk about it – not even to their GP – according to the Continence Foundation of Australia, the peak national organisation for Australians affected by bladder and bowel control problems.
Discussing such a sensitive issue is even more difficult for non-English speaking Australians. Not only is the language barrier a major hurdle, but cultural attitudes and social taboos common to many ethnic groups make the topic a particularly difficult one to broach.
Victorian Continence Resource Centre executive officer Lisa Wragg, who has 20 years continence nursing experience within Melbourne’s ethnic communities, has witnessed firsthand the reluctance of members of culturally and linguistically diverse (CALD) communities to talk about the problem.
“A physiotherapist and I gave a talk to a group of 71 Greek women aged 65 and older. Not one of them had ever talked about their incontinence – to anyone – even though in the evaluation we found all of them had experienced daily incontinence issues,” Ms Wragg said.
“The next day I gave a talk to a mixed Turkish group of about 30, and found that only three individuals had sought assistance, and they were all men with prostate issues.”
This anecdotal evidence is backed by key findings of the Victorian Continence Resource Centre’s 2011 report, Awareness of Incontinence in Ethnic Communities – that knowledge of the causes and treatment of incontinence is low across all CALD communities.
These findings, combined with the low number of calls to the Continence Foundation’s National Continence Helpline (1800 33 00 66) from members of CALD communities, gave rise to the Foundation’s national campaign for 2013, about to be launched during World Continence Week (June 24-30).
The campaign, Talk about incontinence: A problem in anyone’s language, encourages all Australians to openly discuss bladder and bowel health issues and seek help for their incontinence. The campaign supports this year’s special project, Incontinence Outreach in CALD Communities, which aims to raise awareness of continence issues specifically in CALD communities.
An extensive media and advertising campaign, along with several health professional and consumer forums around the country in the lead-up to the launch, were effective in promoting the theme to the wider public.
However, an important component of the campaign is continuing to raise the awareness of health professionals, and equipping them with the skills and knowledge to work effectively and sensitively with all people, including those from CALD backgrounds.
In Ms Wragg’s experience, when patients affected by incontinence go to their GP, it is rarely the predominant health issue they present.
“The average 15-minute GP consultation is not enough time for the GP to ask about any incontinence problems once they’ve dealt with the client’s presenting health issue, so it is often not disclosed,” she said.
According to the Continence Foundation, only 31 per cent of people in a GP’s waiting room have ever sought help for a bladder and bowel control problem, despite the fact they are experiencing some form of incontinence.
“If there is a language barrier, incontinence is even less likely to be identified by the GP,” she said.
Even within a subacute care hospital environment, incontinence issues that may be present are poorly recognised, misdiagnosed and poorly managed, Ms Wragg said.
She said there was a growing body of research drawing similar conclusions.
‘In a subacute care environment, when there is no clear diagnosis of the incontinence problem, the opportunity for an appropriate management plan is missed and management of incontinence relies on expensive containment products and inappropriate discharge planning,” she said.
The importance of interpreter access was highlighted when Ms Wragg, in her former role as continence nurse consultant and manager of a Melbourne continence service, treated an 81-year old Chinese woman whose son (and only next of kin) was temporarily out of the country.
“The woman had collapsed at the shops on one particularly hot day with dehydration, and had developed urinary retention and delirium within 24 hours in the emergency department. She also had faecal impaction. She was referred to us with a label of dementia, and with a urethral catheter inserted. She was understandably extremely emotional,” Ms Wragg said.
After organising an interpreter, it became clear that the woman was not demented, but simply unable to communicate, and extremely relieved to be speaking to someone who understood her. She also discovered the woman had lifelong problems with constipation, and had been eating and drinking very little because she felt full – all of which helped explain her collapse.
“After six weeks treatment for constipation, the catheter was removed, she was mobile, lucid and gaining weight. While this is an extreme example, it highlights the need for health practitioners to be sensitive to the needs of the CALD community, and to access interpreter services where necessary,” Ms Wragg said.
As part of the Incontinence Outreach in CALD Communities project, the Continence Foundation has developed interpreting tools for health professionals and interpreters for use within a continence assessment setting, available to download at continence.org.au/other-languages
One of the project’s most ground-breaking initiatives has been the development of language-specific web pages on the Foundation’s website for non-English speaking communities, and the health professionals who work with them.
The web pages (at continence.org.au/other-languages) are available in 20 languages and provide links to 17 bilingual fact sheets on topics such as pelvic floor muscles, prostate issues and incontinence products. The pages also provide audio translations and videos about where people can go for help.
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