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. 2021 May;205(5):1407-1414.
doi: 10.1097/JU.0000000000001581. Epub 2020 Dec 22.

Measuring Bladder Health: Development and Cognitive Evaluation of Items for a Novel Bladder Health Instrument

Leslie M Rickey  1 , Melissa L Constantine  2 , Emily S Lukacz  3 , Jerry L Lowder  4 , Diane K Newman  5 , Linda Brubaker  3 , Kyle Rudser  2 , Cora E Lewis  6 , Lisa K Low  7 , Mary H Palmer  8 , Todd Rockwood  2
Affiliations

Measuring Bladder Health: Development and Cognitive Evaluation of Items for a Novel Bladder Health Instrument

Leslie M Rickey et al. J Urol. 2021 May.

Abstract

Purpose: We describe the item development and cognitive evaluation process used in creating the Prevention of Lower Urinary Tract Symptoms Bladder Health Instrument (PLUS-BHI).

Materials and methods: Questions assessing bladder health were developed using reviews of published items, expert opinion, and focus groups' transcript review. Candidate items were tested through cognitive interviews with community-dwelling women and an online panel survey. Items were assessed for comprehension, language, and response categories and modified iteratively to create the PLUS-BHI.

Results: Existing measures of bladder function (storage, emptying, sensation components) and bladder health impact required modification of time frame and response categories to capture a full range of bladder health. Of the women 167 (18-80 years old) completed individual interviews and 791 women (18-88 years) completed the online panel survey. The term "bladder health" was unfamiliar for most and was conceptualized primarily as absence of severe urinary symptoms, infection, or cancer. Coping mechanisms and self-management strategies were central to bladder health perceptions. The inclusion of prompts and response categories that captured infrequent symptoms increased endorsement of symptoms across bladder function components.

Conclusions: Bladder health measurement is challenged by a lack of awareness of normal function, use of self-management strategies to mitigate impact on activities, and a common tendency to overlook infrequent lower urinary tract symptoms. The PLUS-BHI is designed to characterize the full spectrum of bladder health in women and will be validated for research use.

Keywords: health status indicators; health surveys; interviews as topic; lower urinary tract symptoms; urinary bladder.

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Conflict of interest statement

Conflicts of Interest: No conflict of interest has been declared by the authors.

Figures

Figure 1
Figure 1
Figure 2
Figure 2
Figure 3.A.
Figure 3.A.
Distribution of responses with dichotomous versus 4-level response categories
Figure 3.B.
Figure 3.B.
Distribution of responses with Guttman versus Likert response structure
Figure 3.C.
Figure 3.C.
Distribution of responses with and without prompt
See this image and copyright information in PMC

Comment in

  • Editorial Comment.
    Lee UJ. Lee UJ. J Urol. 2021 May;205(5):1414. doi: 10.1097/JU.0000000000001581.01. Epub 2021 Mar 17. J Urol. 2021. PMID: 33728940 No abstract available.

References

    1. Harlow BL, Bavendam TG, Palmer MH et al.: The Prevention of Lower Urinary Tract Symptoms (PLUS) Research Consortium: A Transdisciplinary Approach Toward Promoting Bladder Health and Preventing Lower Urinary Tract Symptoms in Women Across the Life Course. J Womens Health (Larchmt), 27: 283, 2018 - PMC - PubMed
    1. Lukacz ES, Bavendam TG, Berry A. et al.: A Novel Research Definition of Bladder Health in Women and Girls: Implications for Research and Public Health Promotion. J Womens Health (Larchmt), 27: 974, 2018 - PMC - PubMed
    1. McDowell I: Measuring health : a guide to rating scales and questionnaires, 3rd ed. New York: OXFORD UNIVERSITY PRESS, 2006
    1. Avery K, Donovan J, Peters TJ et al.: ICIQ: a brief and robust measure for evaluating the symptoms and impact of urinary incontinence. Neurourol Urodyn, 23: 322, 2004 - PubMed
    1. van der Vaart CH, de Leeuw JR, Roovers JP et al.: Measuring health-related quality of life in women with urogenital dysfunction: the urogenital distress inventory and incontinence impact questionnaire revisited. Neurourol Urodyn, 22: 97, 2003 - PubMed

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