Healthcare students in Palestine show moderate knowledge of urinary incontinence

Urinary incontinence, the involuntary leakage of urine, is one of the most widespread yet least discussed conditions in modern medicine. It affects hundreds of millions of people worldwide, eroding quality of life, disturbing sleep, limiting mobility, and social participation, and imposing enormous costs on health systems. Despite its prevalence, the condition is chronically underreported, largely because stigma, misconceptions about aging and childbirth, and embarrassment keep patients from seeking help. Effective management therefore depends on healthcare professionals who are well prepared to recognize the problem, ask the right questions, and offer evidence-based treatment. A new cross-sectional study from Palestine, published in BMC Medical Education, now provides a detailed technical picture of how prepared the next generation of Palestinian clinicians actually is, and the findings reveal both encouraging strengths and persistent educational gaps.

The research team, led by Maaweya Jabareen of Hebron University and the Palestinian Ministry of Health, with Wasef Alhroub of Juzoor for Health and Social Development as corresponding author, surveyed 386 healthcare students from five Palestinian universities between December 2025 and April 2026. The participants, whose mean age was 21.48 years with a standard deviation of 1.81, were predominantly female, with women making up 73.3 percent of the sample. Data were collected using three instruments: a sociodemographic questionnaire, the Urinary Incontinence Knowledge Scale, and the Urinary Incontinence Attitude Scale. The knowledge scale, scored out of a maximum of 30 points, measures factual understanding of urinary incontinence, including its types, risk factors, and management options. The attitude scale, scored out of 60 points, gauges how students view the condition and their willingness to engage with patients who have it.

The results paint a technically nuanced portrait. The mean knowledge score was 19.22, with a standard deviation of 5.51, indicating an overall moderate level of knowledge among the students. The mean attitude score was 43.01, with a standard deviation of 4.52, reflecting generally positive attitudes toward urinary incontinence. In other words, the students neither dismissed the condition nor felt fully confident in their understanding of it. This combination of moderate knowledge and positive attitudes is significant because attitudes often shape whether clinicians proactively screen for incontinence, while knowledge determines whether they can offer accurate advice and appropriate referrals.

Using non-parametric statistical tests, including the Mann-Whitney U test, the Kruskal-Wallis H test, and Spearman’s rank-order correlation, the researchers identified several factors associated with higher knowledge scores. Students who had attended lectures specifically related to urinary incontinence scored significantly higher, with a p value below 0.001. Students who expressed interest in learning about the topic also scored higher, with a p value of 0.022. A family history of urinary incontinence was associated with greater knowledge, with a p value of 0.007, suggesting that personal exposure to the condition sharpens awareness. Students in senior academic years outperformed their junior counterparts, with a p value below 0.001, indicating that knowledge accumulates as students progress through their training. Male students scored higher than female students on the knowledge measure, with a p value of 0.041.

Attitudes, however, followed a different pattern. Female students demonstrated significantly more positive attitudes than male students, with a p value of 0.002. This gender difference is noteworthy because it suggests that knowledge and attitudes are not simply two sides of the same coin. A student can know more about a condition and still hold less favorable views toward it, and vice versa. The researchers also found that knowledge was positively correlated with attitudes, with a Spearman’s r of 0.210 and a p value below 0.001. Although the correlation is modest in magnitude, it is statistically robust, indicating that students who understand urinary incontinence better tend to view it more favorably and are more willing to engage with patients who have it.

To move beyond simple bivariate associations, the team conducted multivariable linear regression using the General Linear Model framework. This approach allowed them to determine which factors independently predicted knowledge and attitude scores when all other variables were held constant. The analysis showed that lack of interest in the topic, absence of prior education about urinary incontinence, no family history of the condition, and earlier academic year independently predicted lower knowledge scores. Less favorable attitudes were independently associated with male gender and lack of interest in the subject. These findings are technically important because they isolate the factors that genuinely drive preparedness rather than merely correlating with it. Prior education emerged as a particularly powerful independent predictor, reinforcing the argument that structured teaching about continence care has a measurable effect on student readiness.

The implications for medical education are substantial. Continence education is frequently limited or absent from undergraduate curricula worldwide, and the Palestinian findings suggest that this gap translates directly into moderate knowledge levels among students who will soon be responsible for patient care. Because urinary incontinence is prevalent in Palestine and help-seeking behavior is low, the burden on future clinicians is likely to be considerable. Students who lack knowledge about the condition may fail to recognize it, may not ask patients about symptoms, and may not offer appropriate management options. Conversely, students with positive attitudes but incomplete knowledge may be willing to engage but unable to provide accurate information. Curriculum reform that integrates structured continence education could address both dimensions simultaneously, building factual understanding while reinforcing the attitudes that encourage proactive patient engagement.

The study also highlights the value of personal and familial exposure to the condition. Students with a family history of urinary incontinence showed greater knowledge, and this effect persisted in the multivariable analysis. This finding suggests that lived experience, whether personal or familial, can compensate for some of the gaps in formal education. It also points to the potential of educational strategies that incorporate patient narratives, case-based learning, and real-world clinical exposure to make continence care more tangible and memorable for students who have no direct experience with the condition.

From a methodological perspective, the study has several technical strengths. The sample of 386 students from five universities provides reasonable geographic and institutional diversity within the Palestinian higher education system. The use of validated instruments, the Urinary Incontinence Knowledge Scale and the Urinary Incontinence Attitude Scale, allows for standardized measurement of the two key dimensions. The combination of non-parametric bivariate tests with multivariable regression using the General Linear Model framework provides a layered analytical approach that captures both simple associations and independent predictors. Ethical approval was obtained from the Institutional Review Board of Hebron University, and all participants provided informed consent in accordance with the Declaration of Helsinki.

The study, which received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors, was published as an open access article under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. The authors declare no competing interests. As the first detailed assessment of healthcare students’ preparedness for continence care in Palestine, the research offers a technical baseline that educators can use to design targeted interventions. The message is clear: moderate knowledge and positive attitudes are a foundation, but not a finished structure. Building true clinical competency in continence care will require deliberate curriculum reform, structured teaching, and educational strategies that connect factual understanding with the attitudes that drive proactive patient engagement. For the students surveyed, and for the millions of patients who will depend on them, the gap between what they know and what they need to know remains the central challenge.

Subject of Research: A cross-sectional study of Palestinian healthcare students found moderate knowledge and generally positive attitudes toward urinary incontinence, with prior education, family history, and academic year independently predicting knowledge scores.

Article Title: Knowledge and attitudes toward urinary incontinence among healthcare students in palestine: a cross-sectional study

Article References: Jabareen, M., Alhroub, W., Bseiso, O., Makhlouf, T. Z., Fasfoos, A., Jubran, M. M., Nassar, B. M., Khanfar, R. W., Sholi, S., Humeedat, M., Qanaeer, B., & Altamimi, M. (2026). Knowledge and attitudes toward urinary incontinence among healthcare students in palestine: a cross-sectional study. BMC Medical Education. https://doi.org/10.1186/s12909-026-10470-w

Image Credits: AI Generated

DOI: 10.1186/s12909-026-10470-w

Keywords: urinary incontinence, healthcare students, Palestine, medical education, continence care, knowledge, attitudes, cross-sectional study, BMC Medical Education, curriculum reform, toward, urinary