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A smartphone app for supporting the self-management of daytime urinary incontinence in adolescents: Development and formative evaluation study of URApp

A smartphone app for supporting the self-management of daytime urinary incontinence in adolescents: Development and formative evaluation study of URApp
A smartphone app for supporting the self-management of daytime urinary incontinence in adolescents: Development and formative evaluation study of URApp

Background: Daytime urinary incontinence (UI) is common in childhood and often persists into adolescence. UI in adolescence is associated with a range of adverse outcomes, including depressive symptoms, peer victimization, poor self-image, and problems with peer relationships. The first-line conservative treatment for UI is bladder training (standard urotherapy) that aims to establish a regular fluid intake and a timed schedule for toilet visits. The success of bladder training is strongly dependent on good concordance, which can be challenging for young people. Objective: This paper aims to describe the development of a smartphone app (URApp) that aims to improve concordance with bladder training in young people aged 11 to 19 years. Methods: URApp was designed by using participatory co-design methods and was guided by the person-based approach to intervention design. The core app functions were based on clinical guidance and included setting a daily drinking goal that records fluid intake and toilet visits, setting reminders to drink fluids and go to the toilet, and recording progress toward drinking goals. The development of URApp comprised the following four stages: a review of current smartphone apps for UI, participatory co-design workshops with young people with UI for gathering user requirements and developing wireframes, the development of a URApp prototype, and the user testing of the prototype through qualitative interviews with 23 young people with UI or urgency aged 10 to 19 years and 8 clinicians. The app functions and additional functionalities for supporting concordance and behavior change were iteratively optimized throughout the app development process. Results: Young people who tested URApp judged it to be a helpful way of supporting their concordance with a timed schedule for toilet visits and drinking. They reported high levels of acceptability and engagement. Preliminary findings indicated that some young people experienced improvements in their bladder symptoms, including a reduction in UI. Clinicians reported that URApp was clinically appropriate and aligned with the best practice guidelines for bladder training. URApp was deemed age appropriate, with all clinicians reporting that they would use it within their own clinics. Clinicians felt URApp would be of particular benefit to patients whose symptoms were not improving or those who were not engaging with their treatment plans. Conclusions: The next stage is to evaluate URApp in a range of settings, including pediatric continence clinics, primary care, and schools. This research is needed to test whether URApp is an effective (and cost-effective) solution for improving concordance with bladder training, reducing bladder symptoms, and improving the quality of life.

Child health, Digital intervention, Incontinence, Intervention development, Mobile phone, Pediatric, Pediatric incontinence, Smartphone, Urinary incontinence
Whale, Katie
560bea51-3169-44db-804f-4fee26c94bec
Beasant, Lucy
a080197b-17cd-46eb-8622-b9b85f072268
Wright, Anne
729024ea-d78f-461a-902d-1c7d97c9e157
Yardley, Lucy
64be42c4-511d-484d-abaa-f8813452a22e
Wallace, Louise
07c96545-3311-43ef-ab3b-9e929cb38122
Moody, Louise
be127c35-3f09-47ff-b0ff-75eef16a6104
Joinson, Carol
2032d233-b409-4642-bd58-b349708b74fe
Whale, Katie
560bea51-3169-44db-804f-4fee26c94bec
Beasant, Lucy
a080197b-17cd-46eb-8622-b9b85f072268
Wright, Anne
729024ea-d78f-461a-902d-1c7d97c9e157
Yardley, Lucy
64be42c4-511d-484d-abaa-f8813452a22e
Wallace, Louise
07c96545-3311-43ef-ab3b-9e929cb38122
Moody, Louise
be127c35-3f09-47ff-b0ff-75eef16a6104
Joinson, Carol
2032d233-b409-4642-bd58-b349708b74fe

Whale, Katie, Beasant, Lucy, Wright, Anne, Yardley, Lucy, Wallace, Louise, Moody, Louise and Joinson, Carol (2021) A smartphone app for supporting the self-management of daytime urinary incontinence in adolescents: Development and formative evaluation study of URApp. JMIR Pediatrics and Parenting, 4 (4), [e26212]. (doi:10.2196/26212).

Record type: Article

Abstract

Background: Daytime urinary incontinence (UI) is common in childhood and often persists into adolescence. UI in adolescence is associated with a range of adverse outcomes, including depressive symptoms, peer victimization, poor self-image, and problems with peer relationships. The first-line conservative treatment for UI is bladder training (standard urotherapy) that aims to establish a regular fluid intake and a timed schedule for toilet visits. The success of bladder training is strongly dependent on good concordance, which can be challenging for young people. Objective: This paper aims to describe the development of a smartphone app (URApp) that aims to improve concordance with bladder training in young people aged 11 to 19 years. Methods: URApp was designed by using participatory co-design methods and was guided by the person-based approach to intervention design. The core app functions were based on clinical guidance and included setting a daily drinking goal that records fluid intake and toilet visits, setting reminders to drink fluids and go to the toilet, and recording progress toward drinking goals. The development of URApp comprised the following four stages: a review of current smartphone apps for UI, participatory co-design workshops with young people with UI for gathering user requirements and developing wireframes, the development of a URApp prototype, and the user testing of the prototype through qualitative interviews with 23 young people with UI or urgency aged 10 to 19 years and 8 clinicians. The app functions and additional functionalities for supporting concordance and behavior change were iteratively optimized throughout the app development process. Results: Young people who tested URApp judged it to be a helpful way of supporting their concordance with a timed schedule for toilet visits and drinking. They reported high levels of acceptability and engagement. Preliminary findings indicated that some young people experienced improvements in their bladder symptoms, including a reduction in UI. Clinicians reported that URApp was clinically appropriate and aligned with the best practice guidelines for bladder training. URApp was deemed age appropriate, with all clinicians reporting that they would use it within their own clinics. Clinicians felt URApp would be of particular benefit to patients whose symptoms were not improving or those who were not engaging with their treatment plans. Conclusions: The next stage is to evaluate URApp in a range of settings, including pediatric continence clinics, primary care, and schools. This research is needed to test whether URApp is an effective (and cost-effective) solution for improving concordance with bladder training, reducing bladder symptoms, and improving the quality of life.

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URApp paper revised - endnoteremove_clean - Accepted Manuscript
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More information

Accepted/In Press date: 21 May 2021
e-pub ahead of print date: 15 November 2021
Published date: 15 November 2021
Keywords: Child health, Digital intervention, Incontinence, Intervention development, Mobile phone, Pediatric, Pediatric incontinence, Smartphone, Urinary incontinence

Identifiers

Local EPrints ID: 450460
URI: http://eprints.soton.ac.uk/id/eprint/450460
PURE UUID: 695d1ab4-136c-48e7-b341-af5ddcece8be
ORCID for Lucy Yardley: ORCID iD orcid.org/0000-0002-3853-883X

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Date deposited: 28 Jul 2021 16:32
Last modified: 17 Mar 2024 02:47

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Contributors

Author: Katie Whale
Author: Lucy Beasant
Author: Anne Wright
Author: Lucy Yardley ORCID iD
Author: Louise Wallace
Author: Louise Moody
Author: Carol Joinson

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