Urinary incontinence (UI) affects both men and women, but its prevalence is higher in women due to life experiences such as pregnancy, childbirth, and menopause. Many women with UI refrain from seeking support due to psychological, social, and cultural factors, with those in patriarchal cultures facing additional barriers. Despite research on the culturally sensitive management of conditions like hypertension within the Sikh community, there is a notable lack of studies addressing UI in this population. There are virtually no studies investigating UI in older Sikh women. This study seeks to fill this gap by exploring how culture influences the attitudes and beliefs of older Sikh women (55+) towards UI.

This qualitative study was with older Sikh women (≥55 years) living in the community. Participants were recruited through convenience and snowball sampling. Semi- structured interviews were conducted in Punjabi in-person and in private settings by a researcher fluent in Punjabi. Informed consent was obtained. The interview explored living situations, health advice preferences, UI experiences, and intergenerational knowledge transmission. Data saturation was reached after 11 interviews, which lasted 14–43 minutes. Interviews were transcribed verbatim and translated into English. Data were analyzed using conventional content analysis; two researchers independently coded the first two transcripts, developed and refined the coding framework. The remaining transcripts were coded by one researcher, with new codes discussed by both. An audit trail and field notes were maintained to ensure confirmability.

A total of 11 Sikh women participated in the study, aged 55 to 75 years (mean age 64.64). All were born in India, with most having spent significant time in rural areas. Participants had diverse educational backgrounds and held various occupational roles, with many identifying as housewives. Ten women lived in multigenerational households, while one lived with her husband. They reported a range of co-morbidities, and 6 had UI with varied severity. Three main themes emerged from the interviews: "have agency over my health/responsible for my well-being," "perceptions of UI and its management," and "lack of conversation."

This study provides insights into the knowledge, attitudes, and beliefs of older Sikh women regarding urinary incontinence (UI). A key finding was that these women expressed a strong sense of agency in managing their health, which contrasts with previous research on South Asian women’s self-care attitudes. Older Sikh women showed interest in promoting pelvic floor health and preventing UI, though perceptions of UI varied, with some viewing it as a normal part of aging or attributing it to divine will. Knowledge of pelvic floor exercises was inconsistent, and some women used herbal remedies, such as jamun fruits, alongside pads and medical consultations. The study also highlighted a lack of open discussion on UI within the Sikh community, with participants noting its normalization. The use of technology, particularly social media, emerged as a potential tool for raising awareness.

The older Sikh women in our study expressed a strong desire for agency over their health and a keen interest in having the right tools to prevent and manage UI. Their diverse perceptions of UI and its management were shaped by cultural beliefs and limited access to informed evidence. These knowledge gaps highlight an important opportunity to design personalized, culturally sensitive health management programs for UI, tailored to the specific needs of this community.