Aversion to Mesh Use in Pelvic Floor Surgery in a Latina Population at the U.S.-Mexico Border.

IMPORTANCE: Limited studies have examined patient aversion to mesh use in pelvic surgery, especially in Latinas. OBJECTIVE: This study aimed to assess aversion to pelvic surgery with mesh for urinary incontinence and pelvic organ prolapse in a sample of Latinas on the U.S.-Mexico border. STUDY DESIGN: This was a cross-sectional study of self-identified Latinas with symptoms of pelvic floor disorders, recruited at their initial consultation visit at a single, academic urogynecology clinic. Participants completed a validated survey to assess perceptions of mesh use in pelvic surgery. Participants also completed questionnaires assessing the presence and severity of pelvic floor symptoms and level of acculturation. The primary outcome was aversion to mesh surgery, as indicated by a response of "yes" or "maybe" to the question "Based on what you already know, would you avoid surgery using mesh?" Descriptive analysis, univariate relative risk, and linear regression analysis were completed to identify characteristics associated with mesh avoidance. Significance was assessed and considered at P values <0.05. RESULTS: Ninety-six women were included. Only 6.3% had prior pelvic floor surgery using mesh. Sixty-six percent indicated that they would be likely to avoid pelvic surgery that uses mesh. Only 9.4% indicated that they obtained information regarding mesh directly from medical professionals. Levels of concern regarding the use of mesh varied widely (29.2% not worried, 19.1% somewhat worried, 16.9% very worried). Higher percentages of "more acculturated" participants indicated a desire to avoid mesh surgery (58.7% vs 27.3%, P < 0.05). CONCLUSIONS: In this Latina population, a majority of patients indicated an aversion to using mesh in pelvic surgery. Few patients obtained information regarding mesh directly from medical professionals, relying instead on nonmedical sources.

Perceptions of Mesh Use for Pelvic Floor Surgery in Latinas: Face Validity of a Spanish Questionnaire.

OBJECTIVE: The aim of the study was to validate a Spanish-translated survey assessing patients' perceptions of mesh use in pelvic floor surgery. METHODS: An English-language survey evaluating perceptions of mesh use underwent a process of Spanish translation and validation, using a forward-backward translation validation protocol. Self-identified bilingual Latinas with symptoms of pelvic floor disorders were recruited to participate in cognitive interviews after completing the survey in English and Spanish. κ coefficient and Cronbach α were calculated for measurement of reliability and internal consistency in responses. A P value of 0.05 was considered statistically significant. RESULTS: A total of 30 women were randomized to complete the initial survey in either English or Spanish. Demographics for the 2 cohorts were similar. For the Spanish-translated survey overall, 86% described the questions as "somewhat easy" or "very easy" to understand, and 93% reported that it was "clear" or "very clear" that the survey aimed to investigate their thoughts regarding mesh use. Approximately 63% of the participants expressed confusion over the use of the Spanish medical term "cabestrillo," translated for "sling." There were no significant differences in the responses on cognitive interview between the 2 groups. Overall, the responses between English and Spanish versions of the survey demonstrated good reliability and internal consistency. CONCLUSIONS: This study demonstrated face validity of a Spanish-translated survey assessing perceptions of mesh use in pelvic surgery in a Latina population. Participants' feedback was crucial to optimizing the quality of the survey for future studies that will evaluate Spanish-speaking patients' views of mesh implants in pelvic reconstructive surgery.