Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Apr 4, 2022
Date Accepted: Sep 26, 2022
Warning: This is an author submission that is not peer-reviewed or edited.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.
Usage of an eHealth intervention for women with stress urinary incontinence: a mixed-methods study
ABSTRACT
Background:
Stress urinary incontinence (SUI) is highly prevalent among women and has an impact on physical and mental well-being. EHealth with pelvic floor muscle training (PFMT) has shown to be effective in reducing complaints. The usage and non-usage attrition of eHealth for SUI is unknown, but knowledge about users and their usage patterns is crucial for implementation purposes.
Objective:
The aim of this study is (1) to evaluate how an eHealth intervention for SUI was used and by whom, (2) to explore reasons for non-usage attrition, and (3) to determine what factors are associated with usage.
Methods:
in this observational, mixed-methods study women with SUI independently registered to a web-based eHealth intervention “Baasoverjeblaas.nl”, a translation of the Swedish internet program "Tät®-treatment of stress urinary incontinence". Login data were collected during three months access to the website, and surveys were sent before and after. Participants were divided into three user groups (low, intermediate, high) and were compared on sociodemographic and incontinence-related characteristics. Nominal logistic regression analysis was used to study factors associated with eHealth usage. Qualitative content analysis was used for open-ended questions about non-usage attrition and about facilitators and barriers to eHealth usage.
Results:
participants (n=561) had a mean age of 50.3 years (12.1 SD) and two-third had never visited a healthcare professional for SUI before. Most users were low users (57.3%), followed by intermediate users (25.8%) and high users (16.9%). User groups differed significantly in age (48.3 years (12.0 SD), 52.1 (11.6 SD) and 55.3 (10.9SD) for low, intermediate and high users, respectively, P< 0.001), and in their expected ability to train the pelvic floor muscles (7.5 (1.4SD), 7.7 (1.4SD), 8.1 (1.5SD), P=0.006). Non-usage attrition was mainly caused by problems fitting PFMT into everyday life. Multivariate analysis revealed that higher age (> 50 years), previous PFMT, and a higher expected ability to train the pelvic floor muscles are associated with higher usage. Facilitators for eHealth usage were the clear explanation of exercises and the possibility of self-management. Its non-committal character and the absence of personal contact, however, hindered usage.
Conclusions:
This study shows that eHealth fulfills a need for women with SUI who have never received treatment. Those who discontinued prematurely did so mainly because it was difficult to integrate the training schedule into their everyday lives. Higher eHealth usage was more likely for women aged over 50 years, with previous PFMT, and with higher expectations about their ability to train the pelvic floor muscles. Knowledge of these user characteristics can guide clinicians and correct their misunderstandings about the suitable target population for this intervention. Furthermore, strategies for reinforcing expectations and self-efficacy are important to upscale eHealth use, together with paying attention to people’s need for personal contact. Clinical Trial: Netherlands Trial Registry (NTR) NTR6956; https://www.trialregister.nl/trial/6570.
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