Women With Urinary Incontinence in Kigali Want Digital Education, but Trust Remains Fragile
Women living with urinary incontinence in Kigali described a condition that reaches far beyond involuntary urine loss. In the phenomenological qualitative study conducted across Masaka, Rwanda Military, Kibagabaga, and King Faisal hospitals, the women spoke about confusion, embarrassment, delayed care, and the daily effort of hiding a problem many had never fully understood. Their accounts place the burden of UI in a familiar but often underrecognized clinical pattern: a pelvic floor disorder that erodes social confidence long before it ever reaches a diagnosis.
The study involved 20 women aged 20 to 70 years and used purposive sampling with thematic analysis based on both deductive and inductive coding. Across the interviews, one message came through with unusual clarity. Women wanted education about UI, but they wanted it delivered in a way they could trust, revisit, and understand on their own terms.
UI remains common worldwide, with prevalence estimates ranging from 20% to 50% among women and about 21% in Sub-Saharan Africa. In this setting, the consequences go well beyond leakage. Participants described fear of odor or visible accidents, social withdrawal, emotional distress, and a sense of isolation that can delay care for months or years. Misinterpretation of symptoms played a major role. Many women confused UI with aging or another unrelated condition, a misconception that can quietly push diagnosis further out of reach.
A single missed explanation can become a long clinical delay.
Knowledge Gaps, Digital Access, and the Search for Something Reliable
The study identified four linked themes, each one shaping how digital health education could work in practice. The first was a substantial knowledge gap about UI itself. Women needed information that addressed misconceptions directly and explained the condition in plain language, because uncertainty about what UI is can be as disabling as the leakage itself. Education also needs to cover available treatments, including medication, surgery, and pelvic floor muscle training or PFMT, since many women remain unaware that UI is treatable rather than simply inevitable.
The second theme centered on technology use. Participants already used digital devices and the internet regularly, and they recognized the value of those tools for health information. Cost mattered, but not always in the way clinicians might assume. Women viewed digital access as affordable relative to other forms of information-seeking, yet the ongoing expense of phones, connectivity, and maintenance still stood in the way for some. In a clinical setting where transport, clinic time, and privacy can all be barriers, the appeal of digital education is obvious: information can be revisited in private, outside the pressure of a waiting room or a rushed consultation.
Still, access alone did not solve the problem.
The third theme was distrust. Women worried about the accuracy of what they encountered online, and that skepticism limited how often they searched for information about UI. For a condition already surrounded by embarrassment, misinformation can deepen hesitation. If a woman is unsure whether symptoms are normal, age-related, dangerous, or simply not worth discussing, she may avoid both online sources and in-person care. In that sense, misinformation functions as a clinical barrier, not a minor inconvenience. It interrupts the path from symptom recognition to diagnosis, and from diagnosis to self-management.
The fourth theme was enthusiasm for multimodal digital education. Participants did not ask for a single channel or a narrow format. They wanted education that could arrive through multiple digital formats and that could be repeated over time. That preference makes practical sense in a condition where comprehension may be low, shame may be high, and symptom patterns may vary. Multimodal delivery offers repetition, reinforcement, and the chance to meet women where they already spend time digitally. It also creates a better fit for PFMT education, which depends on clear instruction, reinforcement, and confidence in technique rather than a one-time explanation.
Why Trusted Digital Messaging Could Change the Care Pathway
The clinical value of digital education in UI lies in its ability to shorten the distance between symptom experience and action. When women learn that leakage is not simply a normal consequence of aging, they may be more likely to seek evaluation earlier. Earlier presentation matters because UI affects quality of life through social avoidance, emotional strain, and financial pressure tied to coping strategies and repeated self-management efforts. A reliable digital platform could also normalize discussion of pelvic floor dysfunction in a way that in-person encounters sometimes cannot, especially for women who feel uncomfortable bringing up leakage directly.
For clinicians and health systems, the findings point toward a very specific communication problem. Women in Kigali are not rejecting digital tools. They are asking for information that is understandable, credible, and repeated in formats that fit their lives. The content must tackle common misconceptions, explain the clinical nature of UI, and make the available treatment options visible. A platform that delivers short, trustworthy, multilingual, or otherwise accessible education could support both symptom recognition and engagement with care.
The study also raises a broader question about the design of digital health in low-resource settings: if a population already uses phones and the internet, the remaining challenge is not whether digital channels exist, but whether the content deserves trust. In UI, trust may determine whether a woman learns about PFMT, discloses symptoms, or continues to suffer in silence.
These findings come from a small qualitative sample in four Kigali hospitals, so the study does not quantify how often each barrier occurs or how strongly any one digital format outperforms another. Even so, the interviews draw a precise clinical map of need: women want accessible digital education, but it must overcome misinformation, financial constraints, and doubt about online content before it can improve UI care.