Accepted for/Published in: JMIR mHealth and uHealth
Date Submitted: Nov 19, 2020
Date Accepted: May 18, 2021
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Barriers and facilitators associated with app-based treatment for female urinary incontinence: a mixed-methods evaluation
ABSTRACT
Background:
App-based treatment for urinary incontinence (UI) is a proven effective and cost-effective alternative to care-as-usual, but successful implementation requires that we identify and address the barriers and facilitators associated with app use.
Objective:
To explore the factors influencing the success or failure of app-based treatment for UI.
Methods:
We used a sequential explanatory mixed-methods design to connect the results of a randomized controlled trial (RCT) with data from semi-structured interviews.A previous RCT had shown the non-inferiority of app-based treatment compared with care-as-usual for UI over 4 months. Participants who experienced success or failure with app-based treatment, as measured by the change in ICIQ-UI-SF symptom score, were selected for telephone interview by purposive sampling (n = 17). The qualitative results were then compared between groups to explore the barriers and facilitators associated with successful app-based treatment.
Results:
Four interrelated themes were identified as affecting treatment: “Adherence,” “Personal Factors,” “App Factors,” and “Awareness.” Adherence-related factors directly influenced the app-based treatment effect and were influenced by the other three themes. Awareness was also influenced by the treatment effect. Several factors were identified that acted as barriers (e.g., time investment), facilitators (e.g., prior pelvic floor muscle therapy), or both (e.g., personality traits and increased awareness of symptoms).
Conclusions:
This study provides useful insights into the barriers and facilitators associated with app-based treatment for UI. These could lead to improved implementation by targeting women most likely to benefit and to increased treatment effectiveness through further development of the app.
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