JMIR Publications

ABSTRACT

Background:

Daytime urinary incontinence is a common childhood condition that can persist into adolescence, it is associated with psychological distress, social and educational difficulties, and increased risk of later mental disorders. The co-designed smartphone app ‘URApp’, was developed in partnership with young people aged 10-18 years to support their self-management of bladder symptoms, but it is not yet utilized by community pediatric continence clinics to facilitate ongoing patient bladder training.

Objective:

To understand barriers and facilitators to embedding a digital health intervention (URApp) designed to aid adherence to bladder training in children and young people with daytime urinary incontinence in community pediatric continence clinics.

Methods:

We conducted a mixed methods process evaluation using the Normalization MeAsure Development questionnaire (NoMAD) at four timepoints to measure behavior change in nursing teams at 6, 12 and 18 weeks. Teams’ responses to questionnaire items were summarized as median scores and plotted at each timepoint using petal plots. Qualitative data were collected using focus groups and interviews and analyzed drawing upon thematic analysis.

Results:

Twenty pediatric continence nurses from five NHS (National Health Service) community pediatric continence clinics in England were recruited through purposive maximum variation sampling. URApp was well-received, nurses were positive about introducing it to patients and felt that URApp’s functionality aligned with existing bladder training provided by NHS community clinics. Nurses reported that URApp was easy to introduce, age-appropriate for children aged 10-18, and was accessible to neurodiverse patients. However, community teams found integration into existing care pathways challenging and did not fully utilize URApp for urotherapy and bladder diary data collection. Teams lacked confidence in changing from paper to electronic bladder diaries, and although they were positive about young people taking ownership of their bladder condition, they struggled to encourage URApp uptake and were concerned about lack of parental oversight of bladder diary data in URApp. Successful uptake and patient engagement with URApp were also negatively impacted by barriers in the school environment, such as lack of access to toilets and smartphones.

Conclusions:

Successful integration of URApp in community pediatric continence clinics requires cultural change in schools around toilet access and healthy drinking. Future implementation of URApp into existing clinical care pathways will need to consider how electronic bladder diary data from URApp can be utilized more effectively by clinical teams, in partnership with patients and their parents/carers to facilitate the shift from analogue to a ‘digital‑first health service’. Clinical Trial: Ethical approval was granted by: University of Bristol Faculty of Health Science Research Ethics Committee (ref:17560). Health Research Authority (HRA) and Health and Care Research Wales (HCRW): IRAS project ID: 338625, Protocol number: 2023-7539.