Challenges in e-Health: The effect of digitalisation of frequency voiding charts on compliance in paediatric patients. Randomised controlled trial comparing digital and versus paper frequency voiding charts

Abstract

Objective: Frequency voiding charts are commonly used to gain better insight into the voiding and drinking behaviours of patients with voiding symptoms. Non-compliance when filling out a chart is known to be high. The use of a digital application might increase adherence, but little research has been conducted on this topic. The aim of this study is to compare the quality (number of correctly filled out charts) and quantity (number of complete charts) of digital versus paper frequency voiding charts among children and their parents.

Methods: A multi-centre parallel randomised controlled trial was conducted. Participants were assigned either a 48-h digital frequency voiding chart or a 48-h paper frequency voiding chart. Completion rates were scored based on a predefined scoring method and transcribed into a percentage. Secondary objectives included user friendliness, feasibility, degree of the child's participation, and attractiveness. Trail registry data: NTR NL9383.

Results: Ninety-seven patients were randomised to either a digital (N = 53) or paper (N = 44) frequency voiding chart. No significant difference in complete and accurately filled out frequency voiding charts was seen between the groups, with 35% (N = 18) for digital and 50% (N = 22) for paper, p = 0.12. Subjects considered the digital application more appealing, more educative, and more inviting compared to the paper chart (p < 0.05).

Conclusions: In this underpowered study, no significant difference appeared between the groups in the number of complete and accurately filled out frequency voiding charts. Implementation of e-health did not seem to improve compliance. In daily practice, personal preference might offer the best solution.

Keywords: Frequency voiding chart; children; digital health < general; mobile phone < media; voiding diary.

Figure 1.

Layout of the paper frequency voiding chart (FVC).

Figure 2.

This figure presents several screenshots of the digital frequency voiding chart (FVC). When translated into English, screenshot left side: How much did your drink? (cup/glass/fruit/dessert), screenshot in the middle: Did you void? Screenshot on the right: Did you have an accident for urine, and if so, what was the amount of urine loss (drip, coin, underpants wet, trousers wet)?.

Figure 3.

Flow chart of enrolment according to the CONSORT guidelines.

Figure 4.

Percentage of child's participation among the different age groups (5–12 years) and type of frequency voiding chart (FVC). A chi-square test was performed for each age group, and p-values are shown. Because age groups from 13 to 16 years contained fewer than two participants each, they were not included.

Figure 5.

Evaluation of subjective aspects of frequency voiding charts (FVCs) reported in percentages. The four-point Likert scale was re-categorised into two categories: Totally, agree and agree into one group and totally not agree/not agree into another group. The percentages shown represent the number of subjects who agree/totally agree with the statement *p < 0.05.