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.
JMIR Pediatr Parent 2021;4(4):e26212
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.
JMIR Pediatr Parent 2021;4(4):e26212
| Original language | English |
|---|---|
| Article number | e26212 |
| Number of pages | 15 |
| Journal | JMIR Pediatrics and Parenting |
| Volume | 4 |
| Issue number | 4 |
| DOIs | |
| Publication status | Published - 15 Nov 2021 |
Bibliographical note
Funding Information:The authors are extremely grateful to all the young people, doctors, and nurses who helped us develop URApp and for the support of the people and organizations, including ERIC, The Children?s Bowel and Bladder Charity, Bladder and Bowel United Kingdom, The Paediatric Continence Forum, and Stuart Church at Pure Usability. The software for URApp was developed by Natural Apptitude [35]. This work was supported by the Elizabeth Blackwell Institute for Health Research, University of Bristol, the Wellcome Trust Institutional Strategic Support Fund (user-centered development of a prototype smartphone application to support the management of daytime urinary incontinence in young people; principal investigator: Joinson), and the Medical Research Council (evaluating the usability, acceptability, and potential effectiveness of a smartphone app to support the management of urinary incontinence and urgency in young people; principal investigator: Joinson). LY is a National Institute for Health Research (NIHR) senior investigator, and her research program is partly supported by the NIHR Applied Research Collaboration?West, NIHR Health Protection Research Unit for Behavioral Science and Evaluation, and the NIHR Southampton Biomedical Research Centre.
Funding Information:
The authors are extremely grateful to all the young people, doctors, and nurses who helped us develop URApp and for the support of the people and organizations, including ERIC, The Children’s Bowel and Bladder Charity, Bladder and Bowel United Kingdom, The Paediatric Continence Forum, and Stuart Church at Pure Usability. The software for URApp was developed by Natural Apptitude [35]. This work was supported by the Elizabeth Blackwell Institute for Health Research, University of Bristol, the Wellcome Trust Institutional Strategic Support Fund (user-centered development of a prototype smartphone application to support the management of daytime urinary incontinence in young people; principal investigator: Joinson), and the Medical Research Council (evaluating the usability, acceptability, and potential effectiveness of a smartphone app to support the management of urinary incontinence and urgency in young people; principal investigator: Joinson). LY is a National Institute for Health Research (NIHR) senior investigator, and her research program is partly supported by the NIHR Applied Research Collaboration–West, NIHR Health Protection Research Unit for Behavioral Science and Evaluation, and the NIHR Southampton Biomedical Research Centre.
Publisher Copyright:
© Katie Whale, Lucy Beasant, Anne J Wright, Lucy Yardley, Louise M Wallace, Louise Moody, Carol Joinson.
Keywords
- incontinence
- urinary incontinence
- digital intervention
- child health
- paediatric
- paediatric incontinence
- smartphone
- intervention development
- mobile phone