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-Dwel (2025)

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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 (1)

Author(s):

Janis M Miller , BSN, MSN, PhD 1 , 2 , ,

Jean F Wyman , PhD 3 ,

Lawrence An , MD 4 , 5 ,

Haitao Chu , MD, PhD 6 ,

Cynthia S Fok , MD 7 ,

Missy Lavender , MBA 8 ,

Cora Elizabeth Lewis , MSPH, MD 9 ,

Alayne D Markland , MSc, DO 10 , 11 ,

Leslie M Rickey , MPH, MD 12 , 13 ,

Ying Sheng , MSN, PhD 1 , 2 , 14 ,

Siobhan Sutcliffe , MHS, ScM, PhD 15 , 16 , 17 ,

Lisa Kane Low , BSN, MS, PhD 1 , 2 ,

Elizabeth R Mueller , MD 18 , 19 ,

The Prevention of Lower Urinary Tract Symptoms (PLUS) Research Consortium 20

Editor(s):

Dahlia Khajeei

Publication date (Electronic): 18 September 2024

Journal: JMIR Research Protocols

Publisher: JMIR Publications

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

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      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

      Related collections

      JMIR: Research Protocols

      Most cited references7

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      An Empirical Evaluation of the System Usability Scale

      Aaron Bangor, Philip Kortum, James Miller (2008)

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        The prevalence of lower urinary tract symptoms (LUTS) in the USA, the UK and Sweden: results from the Epidemiology of LUTS (EpiLUTS) study.

        Karin S Coyne, Chris C Sexton, Christine L Thompson (2009)

        To estimate and compare the prevalence and associated bother of lower urinary tract symptoms (LUTS) in the general populations of the USA, UK and Sweden using current International Continence Society (ICS) definitions, as no previous population-based studies evaluating the prevalence of LUTS in the USA, using the 2002 ICS definitions, have been conducted. This cross-sectional, population-representative survey was conducted via the Internet in the USA, the UK and Sweden. Members of Internet-based panels were randomly selected to receive an e-mailed invitation to participate. If interested, respondents selected a link to an informed consent page, followed by the survey. Participants were asked to rate how often they experienced individual LUTS during the previous 4 weeks, on a five-point Likert scale, and, if experienced, how much the symptom bothered them. Descriptive statistics were used to summarize and present the data. Responses rates for the USA, the UK and Sweden were 59.6%, 60.6% and 52.3%, respectively, with a final sample of 30,000 (USA 20,000; UK 7500; Sweden 2500). The mean age (range) of the participants was 56.6 (40-99) years; the mean percentages for race were 82.9% white, 6.7% black, 6.0% Hispanic and 4.4% Asian/other. The prevalence of LUTS was defined by two symptom frequency thresholds, i.e. at least 'sometimes' and at least 'often' for all LUTS except incontinence, where frequency thresholds were at least 'a few times per month' and at least 'a few times per week'. The prevalence of at least one LUTS at least 'sometimes' was 72.3% for men and 76.3% for women, and 47.9% and 52.5% for at least 'often' for men and women, respectively. For most LUTS, at least half of the participants were bothered 'somewhat' or more using a frequency threshold of at least 'sometimes'. For a threshold of at least 'often', 'somewhat' or more bother was reported by > or =70% of participants except for terminal dribble in men and split stream in women. In this large population study of three countries, LUTS are highly prevalent among men and women aged >40 years. In general, LUTS experienced 'often' or more are bothersome to most people.

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          Forecasting the prevalence of pelvic floor disorders in U.S. Women: 2010 to 2050.

          Richard M. Myers, F Hundley, Xin-Min Wu (2009)

          To estimate the number of women who will have symptomatic pelvic floor disorders in the United States from 2010 to 2050. We used population projections from the U.S. Census Bureau from 2010 to 2050 and published age-specific prevalence estimates for bothersome, symptomatic pelvic floor disorders (urinary incontinence [UI], fecal incontinence, and pelvic organ prolapse [POP]) from the 2005 National Health and Nutrition Examination Survey. We abstracted data regarding the number of women aged 20 years or older in 20-year age groups. We assumed that the age-specific prevalences for these disorders and the population distribution of risk factors remained unchanged thru 2050. We also conducted sensitivity analyses that varied both the prevalence estimates and the population projections. The number of American women with at least one pelvic floor disorder will increase from 28.1 million in 2010 to 43.8 million in 2050. During this time period, the number of women with UI will increase 55% from 18.3 million to 28.4 million. For fecal incontinence, the number of affected women will increase 59% from 10.6 to 16.8 million, and the number of women with POP will increase 46% from 3.3 to 4.9 million. The highest projections for 2050 estimate that 58.2 million women will have at least one pelvic floor disorder, with 41.3 million with UI, 25.3 million with fecal incontinence, and 9.2 million with POP. The prevalence of pelvic floor disorders will increase substantially given the changing demographics in the United States. This increase has important implications for public health and the field of gynecology. III.

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            Author and article information

            Contributors

            Janis M Miller:

            ORCID: https://orcid.org/0000-0003-4604-196X

            Department of Health Behavior and Biological SciencesSchool of NursingUniversity of Michigan400 N. IngallsAnn Arbor, MI, 48109United States1 7347644545janismm@umich.edu

            Journal

            Journal ID (nlm-ta): JMIR Res Protoc

            Journal ID (iso-abbrev): JMIR Res Protoc

            Journal ID (publisher-id): ResProt

            Title: JMIR Research Protocols

            Publisher: JMIR Publications (Toronto, Canada )

            ISSN (Electronic): 1929-0748

            Publication date Collection: 2024

            Publication date (Electronic): 18 September 2024

            Volume: 13

            Electronic Location Identifier: e54046

            Affiliations

            [1 ] Department of Health Behavior and Biological Sciences School of Nursing University of Michigan Ann Arbor, MI United States

            [2 ] Department of Obstetrics and Gynecology School of Medicine University of Michigan Ann Arbor, MI United States

            [3 ] School of Nursing University of Minnesota Minneapolis, MN United States

            [4 ] Department of Internal Medicine University of Michigan Ann Arbor, MI United States

            [5 ] Center for Health Communications Research University of Michigan Ann Arbor, MI United States

            [6 ] Division of Biostatistics School of Public Health University of Minnesota Minneapolis, MN United States

            [7 ] Department of Urology University of Minnesota Minneapolis, MN United States

            [8 ] Renalis Health Cleveland, OH United States

            [9 ] Department of Epidemiology School of Public Health University of Alabama at Birmingham Birmingham, AL United States

            [10 ] Division of Gerontology, Geriatrics, and Palliative Care Department of Medicine, Heersink School of Medicine University of Alabama at Birmingham Birmingham, AL United States

            [11 ] Birmingham/Atlanta Veteran’s Affairs Geriatric Research Educational and Clinical Center Birmingham, AL United States

            [12 ] Department of Urology Yale University New Haven, CT United States

            [13 ] Department of Obstetrics, Gynecology and Reproductive Sciences Yale University New Haven, CT United States

            [14 ] School of Nursing Vanderbilt University Nashville, TN United States

            [15 ] Public Health Sciences Division Department of Surgery Washington University School of Medicine in St. Louis St. Louis, MO United States

            [16 ] Department of Surgery Washington University School of Medicine St. Louis, MO United States

            [17 ] Department of Obstetrics and Gynecology Washington University School of Medicine St. Louis, MO United States

            [18 ] Division of Female Pelvic Medicine and Reconstructive Surgery Department of Obstetrics and Gynecology Loyola University Chicago Chicago, IL United States

            [19 ] Female Urology/Pelvic Medicine & Reconstructive Surgery Loyola University Medical Center Maywood, IL United States

            [20 ] See Acknowledgments

            Author notes

            Corresponding Author: Janis M Miller janismm@ 123456umich.edu

            Author information
            Article

            Publisher ID: v13i1e54046

            DOI: 10.2196/54046

            PMC ID: 11447419

            PubMed ID: 39293052

            SO-VID: f7828f3c-50ea-460d-9153-db217827d60f

            Copyright © ©Janis M Miller, Jean F Wyman, Lawrence An, Haitao Chu, Cynthia S Fok, Missy Lavender, Cora Elizabeth Lewis, Alayne D Markland, Leslie M Rickey, Ying Sheng, Siobhan Sutcliffe, Lisa Kane Low, Elizabeth R Mueller, The Prevention of Lower Urinary Tract Symptoms (PLUS) Research Consortium. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 18.09.2024.

            License:

            This is an open-access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Research Protocols, is properly cited. The complete bibliographic information, a link to the original publication on https://www.researchprotocols.org, as well as this copyright and license information must be included.

            History

            Date received : 30 October 2023

            Date revision requested : 23 March 2024

            Date revision received : 15 April 2024

            Date accepted : 24 June 2024

            Categories

            Subject: Protocol

            Subject: Protocol

            Custom metadata

            ext-peer-rev The proposal for this study was peer-reviewed by the National Institute of Diabetes and Digestive and Kidney Diseases Special Emphasis Panel - National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) - Women's Bladder Health applications PLUS (National Institutes of Health, USA). See Multimedia Appendix 8 for the peer-review report.


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

            Data availability:

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

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            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-Dwel (2025)
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