Language-Concordant Mobile Health Training and Support for Behavioral Management of Urinary Incontinence for Women with Limited English Proficiency

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PROJECT SUMMARY One out of three midlife and older women suffer from urinary incontinence, a condition leading to depression, social isolation, functional decline, and loss of ability to live independently. Although behavioral management strategies such as bladder training and pelvic floor exercises are effective in controlling incontinence, many women with incontinence never receive appropriate training in these first-line behavioral techniques. Furthermore, the usual barriers to engaging in behavioral incontinence management faced by mainstream U.S women are greatly magnified for ethnic minority women with limited English proficiency, who struggle to find healthcare providers who can provide education or support for incontinence in languages other than English. Our research addresses the critical lack of access to training or support for first-line behavioral management of incontinence among ethnic minority women with limited English proficiency. Rather than relying on scarce clinicians who combine clinical expertise in incontinence with fluency in languages other than English, we propose to adapt an interactive, web-based, patient-facing program for behavioral incontinence management (MyHealtheBladder) previously developed by a member of our study team. Designed for smartphones with pictorial, written, and limited audio content, this program offers a potentially accessible, scalable platform for providing language-concordant education and support to diverse women with incontinence in the community. With support from the NIH Office of Research in Women’s Health, we propose to adapt this mobile health program for women from the two largest ethnic minority groups with high rates of limited English proficiency in the United States: Latina women whose preferred language is Spanish, and Chinese American women whose preferred language is Chinese. We will recruit midlife and older women from these backgrounds from the community and obtain their iterative, substantive feedback on the content and format of the mobile health program. Based on pilot-testing of initial language-concordant program versions as well as input from local community organizations focused on Latina and Chinese American health, we will refine program prototypes to pave the way for future follow-up studies that can evaluate feasibility, acceptability, and eventually efficacy of mobile health training in behavioral incontinence management in these populations. If the adapted mobile health program is eventually found to be effective in larger-scale trials, it can be widely disseminated by healthcare systems and community organizations to reduce the burden of incontinence among Spanish- and Chinese-speaking women nationwide, as well as adapted for additional language and ethnic groups in the future. As a result, this research has great potential to decrease disparities in incontinence for demographically important groups who have been marginalized from existing systems of incontinence care.