Mind Over Matter: Electronic Bladder and Bowel Continence Self-management Program
Condition: Incontinence, Urinary; Incontinence Bowel
MeSH terms: Fecal Incontinence; Urinary Incontinence; Enuresis
Study type: Observational

Summary: 
      The objective of this study is to (1) use participatory ergonomics to adapt and in-person
      3-session intervention: Mind Over Matter: Healthy Bowels, Healthy Bladder (MOM) to an
      electronic program (eMOM), and to (2) compare and characterize eMOM's reach when marketed via
      community agencies versus Facebook advertising and to collect qualitative and quantitative
      data about effectiveness and uptake of key behaviors using electronic surveys and phone
      interviews. The study will also collect information from community agencies that might
      implement eMOM about its perceived value and their willingness and capacity to implement such
      a program.
    

Detailed description: 
      More than half of patients hospitalized with serious illness rated urinary and bowel
      incontinence as a state worse than death in a 2016 JAMA (The Journal of the American Medical
      Association) internal medicine study - worse than relying on a breathing machine, being
      unable to get out of bed, or being confused all the time. Unfortunately, over 60% of
      community-dwelling women over age 65 suffer from urinary and/or bowel incontinence,
      accounting for a combined annual cost in excess of $30 billion. In addition to their impact
      on quality of life, social isolation, and depression, urinary and bowel incontinence increase
      caregiver burnout, risk for falls, hospitalization, and nursing home placement. However,
      despite the existence of effective treatments, over half of women with urinary incontinence
      and two-thirds of women with bowel incontinence do not seek medical care. Interventions to
      promote continence in healthcare settings thus reach fewer than half of those in need.

      At University of Wisconsin, research team developed "Mind Over Matter: Healthy Bowels,
      Healthy Bladder" (MOM), which is a small-group, community-based health promotion program that
      builds skills and self-efficacy to make behavior changes that improve urinary and bowel
      symptoms among older women with incontinence. Delivered by a trained facilitator, MOM allows
      senior women to improve their symptoms without seeking medical care. In the randomized,
      controlled trial (RCT) including 122 women in 6 Wisconsin communities, more than 70% of
      participants (versus 23% of controls, p<.0001) achieved improvement in urinary incontinence
      and 55% (versus 26% of controls, p = .0015) achieved improvement in bowel incontinence three
      months following completion of the program, corresponding to a number-needed-to-treat of 3
      for urinary incontinence improvement and 4 for bowel incontinence improvement.

      However, community-based, in-person programs like MOM continue to suffer limited adoption,
      implementation, and reach. Many agencies that adopt and implement such health promotion
      programs are under-resourced and often staffed by volunteers. To ensure intervention
      fidelity, programs like MOM require a large commitment from their resource-stressed hosting
      agencies. Implemented using a "train the trainer" approach organized by the Wisconsin
      Institute for Healthy Aging (WIHA), MOM requires community facilitators to attend a 2-day
      training and then run the workshop series at least twice annually. In addition to the 2-day
      training, it requires approximately 24 person-hours to offer a single MOM workshop series. If
      the trained facilitator leaves or is redirected to other activities, the community agency can
      no longer implement or maintain the program without sending another staff member to be
      trained. In addition to these hurdles at the organization level, there are barriers at the
      individual level.

      In a recent collaboration with the Survey of the Health of Wisconsin (SHOW), it was observed
      that fewer than 20% of women with incontinence (mean age 55 years old) reported being likely
      to attend a continence promotion program with the current, in-person MOM format. In
      qualitative interviews, women expressed concerns about the time commitment, caregiver
      responsibilities at home, issues related to travel (inclement weather, excessive distance to
      reach a community center), and privacy, given the sensitive nature of incontinence. In
      contrast, 65% of women with incontinence reported being likely to participate in an
      electronic continence promotion program, increasing potential reach three-fold.

      Adaptation of the in-person MOM workshop to an electronic format (eMOM) has the potential to
      overcome both individual and organizational hurdles, maximizing reach and minimizing barriers
      to consistent implementation and maintenance. Women with incontinence can complete the
      modules in privacy, at their convenience, and at their own pace. In contrast to the
      commitment required for a community agency to implement the in-person MOM workshop, eMOM can
      be implemented using whatever strategies the agency uses to share other electronic resources
      with their members. eMOM can also be implemented via mass media, such as Facebook. Women age
      65+ account for 11.6% of all Facebook users, and there are more than 200,000 monthly active
      users in this demographic in Wisconsin alone.

      The proposed research will provide invaluable information about the feasibility and reach of
      implementing an electronic health promotion program through mass media versus through
      existing community agencies - information applicable not just to continence promotion but
      also to other health promotion programs trying to overcome similar barriers to reach,
      implementation, and maintenance.
    

Intervention name(s): eMOM
Intervention type(s): Other
Intervention description(s): The intervention is the use of the website (eMOM), which is the electronic adaption of the program, Mind Over Matter: Healthy Bowels, Healthy Bladder (MOM), a small-group, community-based health promotion program that builds skills and self-efficacy to make behavior changes that improve urinary and bowel symptoms among older women with incontinence.
Other intervention name(s): Mind Over Matter: Healthy Bowels, Healthy Bladder" (MOM)
Observational model: Ecologic or Community
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        While eMOM will be promoted specifically for older women, women of any age may access the
        program and participate in the study if they so choose.