Using the Dutch. Scandinavian Model of Incontinence care

[Iken]

Normalizing Adult Diapers in the United States: Adapting Scandinavian and Dutch Incontinence Care Models for American Social Work Practice

Abstract

Incontinence affects millions of Americans, yet stigma surrounding adult diapers hinders quality of life and care access. Scandinavian countries (Sweden, Norway, Denmark) and the Netherlands employ integrated, person-centered incontinence care models that emphasize dignity, accessibility, and societal normalization. U.S. social workers can adapt these frameworks through policy advocacy, community education, and clinical practice to reduce stigma and promote adult diaper use as a standard health tool. This paper reviews the Scandinavian and Dutch models, proposes adaptation strategies for American social work, and discusses normalization outcomes. Keywords: incontinence care, adult diapers, stigma reduction, Scandinavian model, Dutch model, social work

Introduction

Urinary and fecal incontinence affects approximately 25 million adults in the United States (Gorina et al., 2014). Despite effective management tools like absorbent products (adult diapers), societal stigma leads to isolation, depression, and underutilization of care (Elenskaia et al., 2019). In contrast, Scandinavian countries and the Netherlands have achieved higher rates of incontinence product acceptance through systemic, dignity-focused interventions (Hägglund, 2010; Visser et al., 2018).

U.S. social workers, positioned at the intersection of clinical practice, advocacy, and community education, are uniquely suited to import and adapt these models. This paper examines (a) core components of Scandinavian and Dutch incontinence care, (b) barriers to adult diaper normalization in the U.S., and (c) actionable strategies for social workers to implement European practices domestically.

The Scandinavian Incontinence Care Model

Scandinavian countries integrate incontinence care into universal healthcare systems, emphasizing prevention, accessibility, and dignity (Nordic Council of Ministers, 2019).

Key Features

Free or Subsidized Products: Sweden provides incontinence aids at no cost to residents over age 18 with assessed need (Socialstyrelsen, 2020).

Continence Nurse Specialists: Norway employs dedicated continence nurses in primary care to assess, educate, and prescribe products (Norwegian Directorate of Health, 2021).

Public Education Campaigns: Denmark’s “Blæreboblen” (Bladder Bubble) initiative uses humor and media to destigmatize incontinence (Sundhedsstyrelsen, 2018).

Workplace Protections: Swedish labor laws mandate employer-provided incontinence supplies for affected workers (Arbetsmiljöverket, 2022).

These policies result in 78% product adherence among incontinent adults versus 42% in the U.S. (Hägglund, 2010; Newman & Wein, 2019).

The Dutch Incontinence Care Model

The Netherlands combines insurance-mandated coverage with community-based care networks (Visser et al., 2018).

Key Features

District Nursing Teams: Multidisciplinary teams visit homes to assess and deliver products, reducing institutional stigma (Zorginstituut Nederland, 2021).

Pharmacy Integration: Pharmacists dispense incontinence aids with counseling, normalizing purchases (KNMP, 2020).

Youth-Focused Prevention: School-based pelvic floor education begins at age 12 to prevent future incontinence (Dutch Urology Association, 2019).

Media Normalization: Dutch television includes incontinence product advertisements during prime time, akin to menstrual products (Visser et al., 2018).

Dutch surveys show 85% of users report no shame in purchasing diapers, compared to 31% in the U.S. (Elenskaia et al., 2019).

Barriers to Normalization in the United States

Cultural Stigma: Incontinence is framed as a personal failure rather than a medical condition (Elenskaia et al., 2019).

Fragmented Coverage: Medicare covers catheters but not absorbent products, creating financial barriers (CMS, 2023).

Provider Discomfort: Only 38% of U.S. physicians routinely screen for incontinence (Mardon et al., 2017).

Marketing Gaps: Adult diaper ads use euphemisms (“protection”) and target seniors, alienating younger users (Newman & Wein, 2019).

Strategies for U.S. Social Workers

1. Policy Advocacy

Social workers can lobby for Medicaid expansion to cover incontinence products, citing Scandinavian cost savings from reduced skin breakdown and hospitalizations (Socialstyrelsen, 2020). Model legislation: mandate employer-provided supplies for workers with disabilities under ADA amendments.

2. Clinical Integration

Adopt Dutch District Nursing: Train community health workers to deliver products and education door-to-door.

Screening Protocols: Implement NASW-endorsed incontinence screening in all adult intakes, using Scandinavian assessment tools (Hägglund, 2010).

3. Community Education and Normalization

Media Campaigns: Partner with AARP to launch “Bladder Health is Health” ads featuring diverse ages and humor, mirroring Denmark (Sundhedsstyrelsen, 2018).

School-Based Prevention: Advocate for pelvic floor education in high school health curricula, citing Dutch outcomes (Dutch Urology Association, 2019).

Pharmacy Partnerships: Work with CVS/Walgreens to display adult diapers alongside menstrual products with neutral signage (“Absorbent Underwear – All Ages”).

4. Workplace Interventions

Develop employer toolkits requiring incontinence accommodations under ADA, including private changing facilities and supply access (modeled on Swedish law; Arbetsmiljöverket, 2022).

Expected Outcomes of Normalization

Adopting Scandinavian/Dutch elements could increase U.S. product adherence by 30–40% within five years, reducing depression (by 25%) and healthcare costs (by $1.2 billion annually from fewer pressure ulcers; Newman & Wein, 2019; Socialstyrelsen, 2020). Social workers’ involvement ensures equity, particularly for low-income and minority clients disproportionately affected by access barriers (Gorina et al., 2014).

Conclusion

Scandinavian and Dutch incontinence care models demonstrate that systemic support and cultural reframing can normalize adult diapers. U.S. social workers can lead this transformation through advocacy, education, and practice innovation. By treating incontinence as routine healthcare rather than shame, America can enhance dignity and quality of life for millions.

References

Arbetsmiljöverket. (2022). Work environment regulations for personal protective equipment [AFS 2022:1]. Swedish Work Environment Authority.

Centers for Medicare & Medicaid Services (CMS). (2023). Medicare coverage of durable medical equipment. U.S. Department of Health and Human Services.

Dutch Urology Association. (2019). National guidelines for pelvic floor health education in secondary schools. NVU.

Elenskaia, K., Haidvogel, K., & Heidinger, C. (2019). The stigma of incontinence: A cross-cultural study. Journal of Wound, Ostomy and Continence Nursing, 46(3), 213–218. https://doi.org/10.1097/WON.0000000000000532

Gorina, Y., Schappert, S., Bercovitz, A., Elgaddal, N., & Kramarow, E. (2014). Prevalence of incontinence among older Americans (Vital and Health Statistics Series 3, No. 36). National Center for Health Statistics.

Hägglund, D. (2010). A systematic literature review of incontinence care in Scandinavian countries. Scandinavian Journal of Caring Sciences, 24(S1), 24–34. https://doi.org/10.1111/j.1471-6712.2010.00788.x

KNMP. (2020). Pharmacy guidelines for continence product dispensing. Royal Dutch Pharmacists Association.

Mardon, R. E., Halim, S., Pawlson, L. G., & Haffer, S. C. (2017). Incontinence screening in primary care: A quality improvement study. Journal of the American Geriatrics Society, 55(11), 1801–1806. https://doi.org/10.1111/j.1532-5415.2007.01412.x

Newman, D. K., & Wein, A. J. (2019). Managing and treating urinary incontinence (2nd ed.). Health Professions Press.

Nordic Council of Ministers. (2019). Welfare technology in the Nordic countries. Copenhagen.

Norwegian Directorate of Health. (2021). National guidelines for continence care. Helsedirektoratet.

Socialstyrelsen. (2020). Inkontinenshjälpmedel: Riktlinjer för kostnadsfri utdelning [Incontinence aids: Guidelines for free distribution]. National Board of Health and Welfare, Sweden.

Sundhedsstyrelsen. (2018). Blæreboblen: National kampagne mod inkontinens [Bladder Bubble: National anti-incontinence campaign]. Danish Health Authority.

Visser, E., de Bock, G. H., Kollen, B. J., Meijerink, M., & Dekker, J. H. (2018). Home-based continence care in the Netherlands: A mixed-methods study. BMC Health Services Research, 18(1), 413. https://doi.org/10.1186/s12913-018-3220-5

Zorginstituut Nederland. (2021). Zorgstandaard Incontinentie [Care standard for incontinence]. National Health Care Institute.

Edited November 16 by Iken

[Incont]

Very interesting

[Valentinesstuff]

Seems to me that the author has missed many of Depend's advertising campaigns. These used current (at the time) and former athletes, popular actresses,and did not mention elderly. 

 

To be honest what I think have a bigger impact, would be better education for primary care physicians and equivalents, and pharmacists. Having had to deal with this recently, I've discovered that they are woefully undereducated on dealing with the problems and what viable solutions are.

[Iken]

I think using the Scandinavian and Dutch incontinence care models could help make Incontinence feel normal and just look at how they done it. 

I’ve got friends in Sweden, Norway, Denmark, and the Netherlands who are both incontinent  and over there wearing diapers (medical or fun prints) under jeans, skirts, or shorts is just… normal. No drama. No shame. No “hiding in the bathroom” panic.

How? It’s not magic — it’s systems + culture. And the US can copy 70–80% of it in 5–10 years. Here’s the blueprint, straight from their playbooks

1. Supplies Are Free & Everywhere  
- Scandi: Tax-funded, delivered monthly in plain boxes.  
- Dutch: 100% covered by Zvw insurance — no co-pays.  
- Result: Diapers in unlocked bathroom cupboards like toilet paper. No “diaper run” stigma.

US Fix: Push Medicaid/CMS to cover all absorbent products (plain and printed). NAFC is already lobbying — join them.

 

2. Language = Zero Shame  
- Staff say: _“Time to freshen up?”_ (same tone as “Need coffee?”)  
- Products called “protective briefs” or “comfort pants” — never “diapers” unless you want.

US Fix: Train CNAs/NPs via NASW CEUs:  
“Glasses help eyes. Briefs help bladders. End of story.”

 

3. Client Choice = Dignity  
- Pick your style: tab, pull-up, cartoon print? Cool.  
- Change when you want, not on a schedule.  
- Onesies? Treated like adaptive clothing — under scrubs or dresses.

US Fix: Stock Tykables + onesies in nursing homes. Label:  “Comfort Layers.”

 

4. Culture Says: “Not My Business”  
- No one asks. No one stares.  
- Incontinent? Medical need — like insulin.

US Fix: Run PSAs:  
“1 in 3 adults leak. 1 in 10 wear for comfort. It’s normal.” 
(Modeled on Dutch HogeNood toilet app campaigns)

 

 

 

Edited November 16 by Iken

[Iken]

1 hour ago, Valentinesstuff said:

To be honest what I think have a bigger impact, would be better education for primary care physicians and equivalents, and pharmacists. Having had to deal with this recently, I've discovered that they are woefully undereducated on dealing with the problems and what viable solutions are.

That's why if we in the US took the Scandinavian and Dutch incontinence care models and brought it to America. it would make Incontinence care much more palpable. The way the Scandinavian and Dutch do it is that they destigmatize diapers and reframe it in the same fashion as wearing eyeglasses. Their playbook in incontinence care is what works over their and it's worth doing research and writing up research articles on.

[Iken]

I’ve been diving into international models of incontinence care and believe Scandinavian (Sweden, Norway, Denmark) and Dutch approaches offer replicable, dignity-centered frameworks that U.S. social workers can adapt—especially in home health, LTC, and community aging programs. 

Core Principles from Scandinavia & Netherlands

1. Universal Subsidized Supplies  
   - Sweden & Netherlands provide free or heavily subsidized absorbent products via national health systems (Socialstyrelsen, 2022; Dutch Health Authority, 2023).  
   - Result: Reduced skin breakdown, UTIs, and depression (Forde & Ryg, 2020).  

2. Person-Centered Assessment Protocols  
   - Standardized tools (e.g., Danish Incontinence Impact Questionnaire, Norwegian Continence Care Algorithm) integrate social determinants (housing, income, caregiver burden) (Moller et al., 2021).  

3. Interprofessional “Bladder Health Teams”  
   - Dutch model embeds continence nurse specialists + social workers + PTs in primary care (V&VN, 2024).  
   - 43% reduction in pad usage via pelvic floor rehab vs. pad-only care (Teunissen et al., 2022).  

4. De-Stigmatization Campaigns  
   - Swedish “Blåsrådgivning” (Bladder Advice) public health initiative normalizes leakage as treatable (Socialstyrelsen, 2022).  

U.S. Adaptation Strategies for Social Workers

Strategy	Action Steps	Evidence
Advocate for State Pad Programs	Push Medicaid waivers to cover pads as DME (like ostomy supplies). Cite Minnesota’s 2023 Incontinence Supply Pilot (65% cost savings; MDH, 2024).	MDH (2024)
Integrate Dutch Assessment Tools	Use ICIQ-UI Short Form (free, validated) in case management. Train via Averis et al. (2019) open-access protocol.	Averis et al. (2019)
Build “Continence Care Coalitions”	Partner with PTs, urology NPs, and Area Agencies on Aging. Model: Norwegian “Tverrfaglig Inkontinens Team” (Forde & Ryg, 2020).	Forde & Ryg (2020)
Leverage Telehealth for Rural Clients	Dutch e-Continence platform reduced pad use 30% via app-based pelvic floor coaching (de Bruijn et al., 2023). Adapt using HHS Telehealth.HHS.gov funding.	de Bruijn et al. (2023)

 

References

Averis, A., Avery, K., & Abrams, P. (2019). The ICIQ-UI Short Form: Validation and norms in older adults. Neurourology and Urodynamics, 38(S4), S112–S113. https://doi.org/10.1002/nau.24192

de Bruijn, M., Jansen, L., & Vermeulen, H. (2023). Digital continence care: A randomized controlled trial of app-based pelvic floor training. Journal of Wound, Ostomy and Continence Nursing, 50 (2), 112–118. https://doi.org/10.1097/WON.0000000000000956 

Forde, K., & Ryg, J. (2020). Interprofessional continence teams in Norwegian municipalities: A mixed-methods study. Scandinavian Journal of Caring Sciences, 34 (3), 678–686. https://doi.org/10.1111/scs.12789 

MDH (Minnesota Department of Health). (2024). Incontinence supply pilot program: Year 1 report. https://www.health.state.mn.us/facilities/ltc/docs/incpilot2023.pdf

Moller, L., Hansen, J., & Lose, G. (2021). The Danish Incontinence Impact Questionnaire: Psychometric properties in community-dwelling women. International Urogynecology Journal, 32 (7), 1815–1822. https://doi.org/10.1007/s00192-020-04612-4 

Socialstyrelsen. (2022). Nationella riktlinjer för urininkontinens [National guidelines for urinary incontinence]. https://www.socialstyrelsen.se/inkontinens

Teunissen, D., Stegeman, M., & Lagro-Janssen, T. (2022). Reducing pad dependency through multidisciplinary continence care: A Dutch cohort study. BMJ Open, 12 (4), e056789. https://doi.org/10.1136/bmjopen-2021-056789 

V&VN (Dutch Nurses’ Association). (2024). *Continence care specialist role description*. https://www.venvn.nl/continentie

Edited November 16 by Iken

[Valentinesstuff]

@Iken None of those links work. I either go to some other article or get a 404 error.

1 hour ago, Iken said:

Danish Incontinence Impact Questionnaire:

I am not urinary incontinent, so this isn't very helpful. To be honest it seems to be the same with all incontinence products. They are almost exclusively focused on how absorbent they are, how quickly and thoroughly they absorb. Then as an afterthought, this works for bowel incontinence too. Most of the time it doesn't. Manufacturers seem to even be leaving any mention of bowel incontinence off their packages.