Date of Conferral

12-2-2025

Date of Award

December 2025

Degree

Ph.D.

School

Health Services

Advisor

David Segal

Abstract

Sacral neuromodulation (SNM) is a safe and physically well-tolerated third-line treatment using an implantable device for the management of overactive bladder syndrome (OAB). Other first- and second-line treatments for OAB are frequently ineffective and often poorly tolerated. SNM implantation appears to be underutilized compared to other third-line treatments even though SNM has been rated more effective in OAB symptom mitigation with fewer side effects. Thus, the purpose of this quantitative correlational cross-sectional study was to explore whether health services factors are barriers to utilizing SNM implantation as the third-line treatment for OAB in adults. Andersen’s behavioral model of health services use provided the theoretical framework for this study. The research questions addressed whether distance to the urologist, wait time to see the urologist, educational attainment, insurance type, and facility attributes were predictors of SNM device implantation, the dichotomous dependent variable. A purposeful convenience sample of secondary data from a urology clinic and a community hospital within the state of Georgia was used to analyze 204 cases. A binomial logistic regression was conducted to test for an association between the independent and dependent variables using SPSS Version 29. A statistically significant association was found between wait time to see the specialist at less than 51 days (OR .231, p = .002) and between 52-59 days (OR .202, p = < .001). Educational attainment at the college level was also found to be a statistically significant predictor (OR 14.834, p < .001) for SNM implantation.

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