{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T01:44:57Z","timestamp":1789523097938,"version":"build-2803163510"},"reference-count":58,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2023,10,4]],"date-time":"2023-10-04T00:00:00Z","timestamp":1696377600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Research in Nursing &amp; Health"],"published-print":{"date-parts":[[2023,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Urinary incontinence (UI) is experienced by approximately 60% of women in the United States and has a negative impact on self\u2010esteem, sexual function, social participation, and quality of life. Rural women, who are underrepresented in the UI literature, face many health disparities and unique barriers to accessing care. The purpose of this qualitative descriptive study was to explore UI self\u2010management behaviors in rural women with UI, including the contextual factors that influence their approach to self\u2010management. This study recruited rural women, ages 30\u221260 years, using purposive sampling via social media. Demographic information was collected. A semi\u2010structured interview guide was used to conduct individual, in\u2010depth interviews via Zoom. Interview data were analyzed using qualitative description. Sections of interview text were coded using a priori and emergent codes, grouped into categories, and distilled into themes. A total of 31 participants (mean age\u2009=\u200947.2 years) met inclusion\/exclusion criteria, enrolled, and completed the study. Qualitative analysis revealed <jats:italic>rural<\/jats:italic> as a cross\u2010cutting theme and five major themes: <jats:italic>self\u2010management behaviors, familial influence, medical encounters, talking about UI<\/jats:italic>, and <jats:italic>resource scarcity<\/jats:italic>. Participants described the rural environment as having a substantial impact on their approach to UI self\u2010management. Specifically, rural social enmeshment made seeking care for UI in rural communities challenging. Findings shed light on how the rural environment influences various aspects of UI self\u2010management in midlife women. Diverse perspectives in UI self\u2010management are needed to advance knowledge in this field.<\/jats:p>","DOI":"10.1002\/nur.22341","type":"journal-article","created":{"date-parts":[[2023,10,4]],"date-time":"2023-10-04T15:11:20Z","timestamp":1696432280000},"page":"603-615","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["\u201cThe constant worry\u201d: Urinary incontinence self\u2010management in rural women: A qualitative study"],"prefix":"10.1002","volume":"46","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4982-5527","authenticated-orcid":false,"given":"Abbey Jo","family":"Klein","sequence":"first","affiliation":[{"name":"University of Nebraska Medical Center College of Nursing Omaha Nebraska USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christine","family":"Eisenhauer","sequence":"additional","affiliation":[{"name":"Nebraska Total Care Clinical Advisory Board Centene Corporation Omaha Nebraska USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth","family":"Mollard","sequence":"additional","affiliation":[{"name":"University of Nebraska Medical Center College of Nursing Lincoln Nebraska USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meryl","family":"Alappattu","sequence":"additional","affiliation":[{"name":"Department of Physical Therapy University of Florida Gainesville Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcia Y.","family":"Shade","sequence":"additional","affiliation":[{"name":"University of Nebraska Medical Center College of Nursing Omaha Nebraska USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6481-1182","authenticated-orcid":false,"given":"Leeza","family":"Struwe","sequence":"additional","affiliation":[{"name":"Niedfelt Nursing Research Center University of Nebraska Medical Center Lincoln Nebraska USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ann M.","family":"Berger","sequence":"additional","affiliation":[{"name":"University of Nebraska Medical Center College of Nursing Omaha Nebraska USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,10,4]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1177\/1049732320970491"},{"issue":"12","key":"e_1_2_11_3_1","first-page":"2004","article-title":"Health disparities in rural women\u2014ACOG","volume":"586","author":"American College of Obstetricians and Gynecologists","year":"2014","journal-title":"Commitee Opinion ACOG"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/aog.0000000000001148"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/00012272-199712000-00003"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/nau.23116"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1177\/2055207619867223"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2004.07.037"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/GRF.0000000000000613"},{"key":"e_1_2_11_10_1","unstructured":"Centers for Disease Control and Prevention. (2017). About rural health. US Department of Health and Human Services.https:\/\/www.cdc.gov\/ruralhealth\/about.html"},{"key":"e_1_2_11_11_1","unstructured":"Centers for Disease Control and Prevention. (2022). Physical inactivity. US Department of Health and Human Services.https:\/\/www.cdc.gov\/chronicdisease\/resources\/publications\/factsheets\/physical-activity.htm"},{"key":"e_1_2_11_12_1","volume-title":"Designing and conducting mixed methods reserach","author":"Creswell J. W.","year":"2018"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/nur.21743"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1002\/nau.24442"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00192-019-04165-8"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12894-020-00603-8"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12889-015-1658-9"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.18043\/ncm.77.6.423"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.1097\/JU.0000000000000706"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00192-009-0976-9"},{"key":"e_1_2_11_21_1","unstructured":"Health Resources & Services Administration. (2023). Health workforce shortage areas.https:\/\/data.hrsa.gov\/topics\/health-workforce\/shortage-areas"},{"key":"e_1_2_11_22_1","unstructured":"IBM Corp. (2020). IBM SPSS statistics for windows. Version 27.0."},{"key":"e_1_2_11_23_1","doi-asserted-by":"publisher","DOI":"10.7257\/1053-816X.2021.41.4.195"},{"key":"e_1_2_11_24_1","doi-asserted-by":"publisher","DOI":"10.1002\/nau.24237"},{"key":"e_1_2_11_25_1","doi-asserted-by":"publisher","DOI":"10.1177\/1049732315617444"},{"key":"e_1_2_11_26_1","doi-asserted-by":"publisher","DOI":"10.1080\/13697137.2021.1915272"},{"key":"e_1_2_11_27_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0251711"},{"key":"e_1_2_11_28_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00192-020-04644-3"},{"key":"e_1_2_11_29_1","doi-asserted-by":"publisher","DOI":"10.1177\/1049732315588501"},{"key":"e_1_2_11_30_1","doi-asserted-by":"publisher","DOI":"10.7326\/M18-0595"},{"key":"e_1_2_11_31_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10488-013-0528-y"},{"key":"e_1_2_11_32_1","doi-asserted-by":"publisher","DOI":"10.1002\/nau.24222"},{"key":"e_1_2_11_33_1","doi-asserted-by":"publisher","DOI":"10.1002\/nau.24986"},{"key":"e_1_2_11_34_1","doi-asserted-by":"publisher","DOI":"10.1097\/won.0000000000000383"},{"key":"e_1_2_11_35_1","doi-asserted-by":"publisher","DOI":"10.1097\/spv.0000000000001127"},{"key":"e_1_2_11_36_1","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph16193781"},{"key":"e_1_2_11_37_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12913-020-06047-y"},{"key":"e_1_2_11_38_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurpub\/ckx151"},{"key":"e_1_2_11_39_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.outlook.2008.10.004"},{"key":"e_1_2_11_40_1","doi-asserted-by":"publisher","DOI":"10.1097\/won.0000000000000537"},{"key":"e_1_2_11_41_1","volume-title":"The coding manual for qualitative researchers","author":"Salda\u00f1a J.","year":"2021"},{"key":"e_1_2_11_42_1","doi-asserted-by":"publisher","DOI":"10.1002\/nau.24256"},{"key":"e_1_2_11_43_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.androl.2018.08.003"},{"key":"e_1_2_11_44_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12905-022-02067-4"},{"key":"e_1_2_11_45_1","doi-asserted-by":"publisher","DOI":"10.1177\/08901171221134797"},{"issue":"7","key":"e_1_2_11_46_1","first-page":"459","article-title":"Guideline, with no evidence, suggests annual screening for urinary incontinence in women","volume":"99","author":"Shaughnessy A. F.","year":"2019","journal-title":"American Family Physician"},{"key":"e_1_2_11_47_1","doi-asserted-by":"publisher","DOI":"10.1590\/1981-22562022025.210207"},{"key":"e_1_2_11_48_1","doi-asserted-by":"publisher","DOI":"10.1080\/01443615.2022.2040966"},{"key":"e_1_2_11_49_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.healthplace.2020.102396"},{"key":"e_1_2_11_50_1","doi-asserted-by":"publisher","DOI":"10.1177\/1756287218814382"},{"key":"e_1_2_11_51_1","doi-asserted-by":"publisher","DOI":"10.2196\/jmir.5698"},{"key":"e_1_2_11_52_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12894-019-0555-4"},{"key":"e_1_2_11_53_1","unstructured":"US Department of Agriculture. (2017).Rural education at a glance 2017 edition.https:\/\/www.ers.usda.gov\/publications\/pub-details\/?pubid=83077"},{"key":"e_1_2_11_54_1","unstructured":"US Department of Agriculture. (August 2020). Rural\u2010urban commuting area codes.https:\/\/www.ers.usda.gov\/data-products\/rural-urban-commuting-area-codes\/"},{"key":"e_1_2_11_55_1","doi-asserted-by":"publisher","DOI":"10.1111\/medu.13124"},{"key":"e_1_2_11_56_1","unstructured":"VERBI Software. (2021). MAXQDA 2022."},{"key":"e_1_2_11_57_1","doi-asserted-by":"publisher","DOI":"10.2196\/jmir.7071"},{"key":"e_1_2_11_58_1","doi-asserted-by":"publisher","DOI":"10.1097\/WON.0000000000000928"},{"key":"e_1_2_11_59_1","unstructured":"Zoom Video Communications Inc. (2022). Zoom(Version 5.12.2) [Computer software].https:\/\/zoom.us\/"}],"container-title":["Research in Nursing &amp; Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/nur.22341","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,11,7]],"date-time":"2023-11-07T13:57:26Z","timestamp":1699365446000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/nur.22341"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,10,4]]},"references-count":58,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2023,12]]}},"alternative-id":["10.1002\/nur.22341"],"URL":"https:\/\/doi.org\/10.1002\/nur.22341","archive":["Portico"],"relation":{},"ISSN":["0160-6891","1098-240X"],"issn-type":[{"value":"0160-6891","type":"print"},{"value":"1098-240X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,10,4]]},"assertion":[{"value":"2023-04-25","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-09-17","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-10-04","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}