Item Development for the Psychosocial Impact of Assistive Devices Scale for Continence (C-PIADS)
Authors: Jutai J.W.  , Fowler S.  , Southall K.  , van den Heuvel E.  , Long A.  
Published: February 2025

Urinary incontinence (UI) poses problems for millions of people of varying ages worldwide. Continence symptoms can be ameliorated with pelvic floor rehabilitation, drugs, or operational intervention. In addition there is a great variety of assistive technology devices (ATDs) used to aid continence management. Because continence difficulties (CD) can profoundly affect an individual&apos;s participation in society and, thereby, their health-related quality of life, it is important to have valid, responsive and sensitive measure of the impact of these devices on psychosocial experiences. One such tool, a 26-item self-report questionnaire the Psychosocial Impact of Assistive Devices Scale (PIADS) has been shown to reliably predict the adoption and use of ATDs. Our study was to investigate if and how this instrument could be modified to be sensitive to the use of continence management devices. The study used interpretive methods in which qualitative information from semi-structured interviews was combined with the findings from cognitive interviews for questionnaire pre-testing to inform the development of a new questionnaire. A total of 40 participants from Canada and UK were recruited. All interviewees self-reported CD &ndash; bladder and/or bowel - and use of ATDs to manage continence symptoms. Semi-structured interviews, lasting between 10 and 30 minutes, were conducted with all participants. The objective was to provide opportunities for interviewees to spontaneously (i.e. without reference to PIADS) identify important concerns and issues that should be considered for developing a version of the PIADS for continence technologies. Twenty-nine participants were also asked to complete the paper version of the PIADS questionnaire while considering their currently used continence device or product. They were asked to comment on the suitability and appropriateness of PIADS for assessing quality of life outcomes resulting from UI intervention and how well the questionnaire captured the impact of continence management products and devices. Finally, they were encouraged to suggest supplemental items, (i.e. issues not represented in the PIADS) perceived to impact upon quality of life outcomes following UI intervention. Results of the in-depth semi-structured questionnaires so far, reflect the findings from similar studies carried out on Foley catheter users with frequent references to the inconvenience, embarrassment and resignation to their condition. Generally, participants appeared to be able to complete the PIADS without difficulty and indicated that the tool reflected their primary psychosocial concerns with continence devices. Some indications for additional items, such as those related to stigma, are emerging. A version for continence, the C-PIADS, will require some modifications to the PIADS, and is likely to contain the addition of some new items. Following our full analysis a draft C-PIADS will be produced and this will be tested and validated as part of a European ERA-net grant in 2014.