Tailoring Online Continence Promotion for Women

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PROJECT SUMMARY Incontinence is common, costly, and vastly undertreated in women. Urinary and bowel incontinence often co-occur and impact more than half of women after menopause, with healthcare costs in excess of $30 billion per year. Lifestyle changes are recommended as first- line treatment but most women are not aware of these strategies because they do not seek care. Bringing information about these solutions to women outside the healthcare setting and empowering them to make these behavior changes has the potential to improve symptoms, impact quality of life, and decrease healthcare costs for millions of women. Our team developed and tested Mind Over Matter: Healthy Bowels, Healthy Bladder (MOM), a small-group behavior change intervention that improves urinary and bowel incontinence in women age 50 and older. This program is innovative in its inclusion of strategies to improve both bladder and bowel incontinence; its reach, however, is limited because it is delivered to small groups in community settings. Our prior research showed that less than 20% of women with incontinence would participate in a program like MOM, while over 60% would participate in an online continence promotion program. Our team therefore obtained pilot funding to adapt MOM to an online platform and demonstrated tremendous reach compared to the in-person program (>4,000 users in 3 months versus <300 users in 12 months). However, the majority of participants visited the program only once and did not adopt behavior changes. Other disciplines have used tailoring, a process through which inputs from a specific user are processed to generate individualized outputs, to enhance engagement with electronic health promotion. Tailoring has not been widely studied in continence promotion despite NIDDK recognizing individualization of treatment for urinary incontinence as a significant research priority. We propose a randomized controlled trial testing the impact of tailoring (versus an active control group with scheduled digital reminders) on engagement with online MOM and adoption of health behaviors that improve continence. We hypothesize that those with a tailored experience will use the program more and be more likely to make behavior changes. In the final aim, we explore mechanisms through which tailoring impacts behavior change. Our team approaches improving continence promotion from a transdisciplinary perspective (psychology, human factors engineering, health communication theory, and urogynecology) and proposes a study with potential to significantly advance our understanding of how to personalize behavioral treatment for incontinence.