JMIR Publications

ABSTRACT

Background:

Background:

Daily life challenges affect toileting management. Studies of learning strategies to maximize situationally based bladder control are scarce.

Objective:

Objective:

We tested confidentbladder.org: a fully automated, evidence-based website tutorial for its effects on knowledge, self-efficacy, and behaviors for optimizing bladder control through Bandura’s Social Learning Theory via animated story-format.

Methods:

Methods:

In a 3-arm partially blinded randomized controlled trial, 90 midlife women, 30 per group, were assigned to one of two experimental groups or to the control group. Experimental group respondents viewed either the Daytime Confidence (Day) or the Sleep/Wake Confidence (Sleep) tutorial segments. Qualtrics Research Services managed all web-based study services: recruitment (from affiliated research panels), questionnaire self-assessments, randomization, and confidentbladder.org access. Session 1, after informed consent procedures, all respondents completed a Demographics Form and the Confident Bladder Behaviors Questionnaire. Session 2, intervention groups were given links to their assigned segments of the tutorial, which took about 10 minutes to watch. The control group saw no tutorial. Thereafter, all groups completed Confident Bladder Knowledge and Self-efficacy questionnaires. Session 3, two weeks later, all groups completed the follow-up Bladder Behaviors Questionnaire. We used Web analytics to match IP addresses from the Qualtrics assessment site to IP addresses on the confidentbladder.org site.

Results:

Results:

Of 721 participants assessed for eligibility, 203 were randomized, 113 were excluded, and 90 completed the study. Web analytics determined that 20 of 60 participants claiming to view confidentbladder.org did not appear to do so. Intent-to-treat ANOVAs showed group differences in Knowledge (0-10 points possible) with Day mean=8.43, Sleep mean=8.03, Control mean=6.00 (F (2, 87) =5.42, p=.006), η2= .11, 90% CI[02,.21], and Self-Efficacy (0-100% possible) Day mean=95.0, Sleep mean=93.97, Control mean=79.37 (F (2, 87)=4.77, p=.011), η2= .10, 90% CI[01,.19]. As expected, the intervention groups did not differ from each other on either questionnaire but were higher than the control group on both. Regarding the Bladder Behaviors Questionnaire (Likert-scale 1-6), a mixed ANOVA on the 9-item factor “Gentle Pelvic Contractions” to boost in-the-moment bladder control showed a significant interaction between time of testing (Session 1 vs Session 3) and Group (F(2,87)=6.47, p=.002, ,η2= .13, 90% CI[03,.23]). Again, no differences were found between the two intervention groups, with each group reporting significantly increased use of gentle pelvic contractions for bladder control: Day mean=21.97 points and Sleep mean=22.87 points. The Control group differed significantly from both intervention groups, with Control mean=13.03 points. A mixed ANOVA on the 11-item factor “Bladder Worry” of the Behaviors questionnaire showed no significant findings. Participants (96%) reported they would recommend the tutorial to others.

Conclusions:

Conclusions:

Results show a well-designed engaging non-sponsored website improves women’s confidence in bladder control, which may have long-term positive impacts on early and late aging life stages. Trial Registration: ClinicalTrials.gov NCT06921915; http://clinicaltrials.gov/study/ NCT06921915 Clinical Trial: Trial Registration: ClinicalTrials.gov NCT06921915; http://clinicaltrials.gov/study/ NCT06921915