Design of a Tool Capable of Assessing Environmental Sociocultural Physical Factors Influencing Women's Decisions on When and Where to Toilet Within Real-World Settings: Protocol for the Build and Usability Testing of a Mobile App for Use by Community-Dwelling Women

Abstract

Background: Although surveys and apps are available for women to report urination and bladder symptoms, they do not include their decisions regarding toileting. Real-world factors can interfere with toileting decisions, which may then influence bladder health. This premise lacks data per want of a robust data collection tool.

Objective: The Prevention of Lower Urinary Tract Symptoms (PLUS) research consortium engaged a transdisciplinary team to build and test WhereIGo, a mobile data collection app for Android and iOS. The design goal was a comprehensive reporting system for capturing environmental, sociocultural, and physical factors that influence women's decisions for toileting. Aims include having (1) an innovative feature for reporting physiologic urge sensation when "thinking about my bladder" and shortly before "I just peed," (2) real-time reporting along with short look-back opportunities, and (3) ease of use anywhere.

Methods: The development team included a plain language specialist, a usability specialist, creative designers, programming experts, and PLUS scientific content experts. Both real-time and ecological momentary assessments were used to comprehensively capture influences on toileting decisions including perceived access to toileting, degree of busyness or stress or focus, beverage intake amount, urge degree, or a leakage event. The restriction on the maximal number of taps for any screen was six. PLUS consortium investigators did pilot-testing. Formal usability testing relied on the recruitment of community-dwelling women at four PLUS research sites. Women used the app for 2 consecutive days. Outcome measures were the system usability scale (SUS; 0-100 range) and the functional Mobile Application Rating Scale (1-5 range). These scales were embedded at the end of the app. The estimated a priori sample size needed, considering the SUS cut point score set at ≥74, was 40 women completing the study.

Results: Funding was provided by the National Institute of Diabetes and Digestive and Kidney Diseases since July 2015. The integrity of the build process was documented through multiple 5-minute videos presented to PLUS Consortium and through WhereIGo screenshots of the final product. Participants included 44 women, with 41 (93%) completing data collection. Participants ranged in age from 21 to 85 years, were predominantly non-Hispanic White (n=25, 57%), college-educated (n=25, 57%), and with incomes below US $75,000 (n=27, 62%). The SUS score was 78.0 (SE 1.7), which was higher than 75% of the 500 products tested by the SUS developers. The mean functional Mobile Application Rating Scale score was 4.4 (SE 0.08). The build and informal acceptability testing were completed in 2019, enrollment for formal usability testing completed by June 2020, and analysis was completed in 2022.

Conclusions: WhereIGo is a novel app with good usability for women to report toileting decisions, urination, and fluid intake. Future research using the app could test the influence of real-time factors on bladder health.

International registered report identifier (irrid): RR1-10.2196/54046.

Keywords: ecological momentary assessment; mobile app; mobile phone; population studies; real-world environment; time factors; toileting; urinary bladder; woman’s health.

Figure 1

Visual representation of selected key screenshots of WhereIGo, an app designed to collect data on toileting decisions made by community-dwelling women in real time wherever they are. Each of the 5 screens shown here leads to additional data collection screens under these lead messages: screen 1 logo, screens 2 and 3 real-time tap me components (“I’m thinking about my bladder” or “Now I peed”), screen 4 notification as heads-up for an upcoming look-back check-in (reflecting on the past 3-4 hours), screen 5 pin drop locator of common locations (home location pin required and opportunity to pin and name other locations as clarity of meaning for geocoding). Short look-back periods called “check-ins” were also offered with 3-5 push notifications per day that take the user to the menu. These prompts were to ascertain difficulty on the part of the participant in self-initiating reports on the main variable of interest—a toileting event. Screen 4 shows when the user’s next check-in time will be as a form of anticipatory guidance using the push notification. Screen 5 shows the “pin-drop” feature used to identify a user’s “home” location and optionally label other common locations such as “work.” Screenshots of the entire WhereIGo app (its 72 “screen-pages” and an additional 15 exit survey items) are available in Multimedia Appendix 1.