An evidence-based self-management package for urinary incontinence in older women: a mixed methods feasibility study

Abstract

Background: Urinary incontinence (UI) is a distressing condition that limits women's quality of life and places a heavy burden on health care services. Behavioural treatments are recommended as a first-line treatment. An evidence-based self-management package was developed following the Medical Research Council (MRC) framework for complex interventions. This study aimed to evaluate the feasibility and acceptability of the intervention.

Methods: A mixed-methods approach was undertaken, namely a randomised controlled feasibility study with nested qualitative study. Fifty women aged 55 or over living with UI, recruited from community centres were randomly assigned to either a 3-month course with the package with a support session or a control group to receive the same package only 3 months later. Principal outcome measures were: self-reported quality of life, UI severity, self-efficacy and psychological status. Analysis of covariance was undertaken to estimate within- and between- group changes for all outcomes. Acceptability was explored using individual interviews at follow-up.

Results: Fifty women were randomised (24 to intervention, 26 to control); mean age of 69.7 (±9.1) years and mean UI frequency 2.2 (±2.2) episodes/day at baseline. Overall, 49 women (98%) completed 3-month follow-up (24 in the intervention, 25 in the control). A positive trend was detected in the impact of UI on their personal relationships (- 3.89, p = 0.088), symptom severity (- 1.77, p = 0.025), UI symptoms scale (- 1.87, p = 0.031) and anxiety status (- 2.31, p = 0.001), respectively. Changes in quality of life and self-efficacy did not differ significantly between groups. Majority of women (71%) in the intervention group reported subjective improvement after 3 months. Spearman correlation coefficient was 0.43 (p < 0.05) between their subjective perception of change and self-efficacy. Women perceived the package being acceptable and described that the package had the potential to increase their knowledge and confidence to manage symptoms and improve quality of life.

Conclusions: The study demonstrated that the self-management package is feasible and acceptable for older women with UI. Further studies are needed with a large sample size in clinical settings to evaluate the effectiveness of this package.

Trial registration: ISRCTN17194896. Registered on 11th September 2019 (retrospectively registered).

Keywords: Acceptability; Feasibility; Mixed methods; Randomised controlled trial; Self-management; Urinary incontinence.

Fig. 1

Mean (95 and 90% confidence intervals) of pre-post intervention differences and treatment effect for EQ-5D

Fig. 2

Mean (95 and 90% confidence intervals) of pre-post intervention differences and treatment effect for EQ-5D utility and VAS scores

Fig. 3

Mean (95 and 90% confidence intervals) of pre-post intervention differences and treatment effect for KHQ, Part I

Fig. 4

Mean (95 and 90% confidence intervals) of pre-post intervention differences and treatment effect for KHQ, Part II

Fig. 5

Mean (95 and 90% confidence intervals) of pre-post intervention differences and treatment effect for KHQ, Part III

Fig. 6

Mean (95 and 90% confidence intervals) of pre-post intervention differences and treatment effect for ICIQ-UI SF

Fig. 7

Mean (95 and 90% confidence intervals) of pre-post intervention differences and treatment effect for GSE-UI

Fig. 8

Mean (95 and 90% confidence intervals) of pre-post intervention differences and treatment effect for HADS, Anxiety

Fig. 9

Mean (95 and 90% confidence intervals) of pre-post intervention differences and treatment effect for HADS, Anxiety