Whale Katie, Beasant Lucy, Wright Anne J, Yardley Lucy, Wallace Louise M, Moody Louise, Joinson Carol
Centre for Academic Child Health, Bristol Medical School, University of Bristol, Bristol, United Kingdom.
Evelina London Children's Hospital, Guy's and St Thomas', NHS Foundation Trust, London, United Kingdom.
JMIR Pediatr Parent. 2021 Nov 15;4(4):e26212. doi: 10.2196/26212.
Daytime urinary incontinence (UI) is common in childhood and often persists into adolescence. UI in adolescence is associated with a range of adverse outcomes, including depressive symptoms, peer victimization, poor self-image, and problems with peer relationships. The first-line conservative treatment for UI is bladder training (standard urotherapy) that aims to establish a regular fluid intake and a timed schedule for toilet visits. The success of bladder training is strongly dependent on good concordance, which can be challenging for young people.
This paper aims to describe the development of a smartphone app (URApp) that aims to improve concordance with bladder training in young people aged 11 to 19 years.
URApp was designed by using participatory co-design methods and was guided by the person-based approach to intervention design. The core app functions were based on clinical guidance and included setting a daily drinking goal that records fluid intake and toilet visits, setting reminders to drink fluids and go to the toilet, and recording progress toward drinking goals. The development of URApp comprised the following four stages: a review of current smartphone apps for UI, participatory co-design workshops with young people with UI for gathering user requirements and developing wireframes, the development of a URApp prototype, and the user testing of the prototype through qualitative interviews with 23 young people with UI or urgency aged 10 to 19 years and 8 clinicians. The app functions and additional functionalities for supporting concordance and behavior change were iteratively optimized throughout the app development process.
Young people who tested URApp judged it to be a helpful way of supporting their concordance with a timed schedule for toilet visits and drinking. They reported high levels of acceptability and engagement. Preliminary findings indicated that some young people experienced improvements in their bladder symptoms, including a reduction in UI. Clinicians reported that URApp was clinically appropriate and aligned with the best practice guidelines for bladder training. URApp was deemed age appropriate, with all clinicians reporting that they would use it within their own clinics. Clinicians felt URApp would be of particular benefit to patients whose symptoms were not improving or those who were not engaging with their treatment plans.
The next stage is to evaluate URApp in a range of settings, including pediatric continence clinics, primary care, and schools. This research is needed to test whether URApp is an effective (and cost-effective) solution for improving concordance with bladder training, reducing bladder symptoms, and improving the quality of life.
日间尿失禁（UI）在儿童期很常见，且常常持续到青春期。青春期尿失禁与一系列不良后果相关，包括抑郁症状、同伴欺侮、自我形象不佳以及同伴关系问题。尿失禁的一线保守治疗方法是膀胱训练（标准尿疗法），其目的是建立规律的液体摄入量和定时如厕时间表。膀胱训练的成功很大程度上取决于良好的依从性，而这对年轻人来说可能具有挑战性。
本文旨在描述一款智能手机应用程序（URApp）的开发过程，该应用旨在提高11至19岁年轻人在膀胱训练中的依从性。
URApp采用参与式协同设计方法进行设计，并以基于人的干预设计方法为指导。该应用的核心功能基于临床指南，包括设定每日饮水目标以记录液体摄入量和如厕情况、设置饮水和如厕提醒，以及记录朝着饮水目标取得的进展。URApp的开发包括以下四个阶段：对当前用于尿失禁的智能手机应用程序进行审查；与患有尿失禁的年轻人举办参与式协同设计研讨会，以收集用户需求并绘制线框图；开发URApp原型；通过对23名年龄在10至19岁的患有尿失禁或尿急的年轻人以及8名临床医生进行定性访谈，对该原型进行用户测试。在整个应用程序开发过程中，对支持依从性和行为改变的应用功能及附加功能进行了迭代优化。
测试URApp的年轻人认为它是帮助他们遵守定时如厕和饮水时间表的一种有用方式。他们报告了该应用的高可接受性和参与度。初步研究结果表明，一些年轻人的膀胱症状有所改善，包括尿失禁减少。临床医生报告称，URApp在临床上是合适的，并且符合膀胱训练的最佳实践指南。URApp被认为适合该年龄段，所有临床医生都表示他们会在自己的诊所中使用它。临床医生认为，URApp对症状未改善或未遵守治疗计划的患者将特别有益。
下一阶段是在一系列环境中对URApp进行评估，包括儿科尿失禁诊所、初级保健机构和学校。需要进行这项研究来测试URApp是否是一种有效（且具有成本效益）的解决方案，以提高膀胱训练的依从性、减轻膀胱症状并改善生活质量。
