PMID- 36394923 OWN - NLM STAT- MEDLINE DCOM- 20221121 LR - 20221205 IS - 1438-8871 (Electronic) IS - 1439-4456 (Print) IS - 1438-8871 (Linking) VI - 24 IP - 11 DP - 2022 Nov 17 TI - Usage of a Web-Based eHealth Intervention for Women With Stress Urinary Incontinence: Mixed Methods Study. PG - e38255 LID - 10.2196/38255 [doi] LID - e38255 AB - BACKGROUND: Stress urinary incontinence (SUI) is highly prevalent among women and has an impact on physical and mental well-being. eHealth with pelvic floor muscle training (PFMT) has shown to be effective in reducing complaints. The usage and nonusage attrition of eHealth for SUI is unknown, but knowledge about users and their usage patterns is crucial for implementation purposes. OBJECTIVE: This study aimed to evaluate how an eHealth intervention for SUI was used and by whom, explore reasons for nonusage attrition, and determine what factors are associated with usage. METHODS: In this observational, mixed methods study, women with SUI independently registered to a web-based eHealth intervention, Baas over je blaas, a translation of the Swedish internet program Tat-treatment of stress urinary incontinence. Log-in data were collected during 3-month access to the website, and surveys were sent at baseline. Participants were divided into three user groups (low, intermediate, and high) and were compared based on sociodemographic and incontinence-related characteristics. Nominal logistic regression analysis was used to study factors associated with eHealth usage. Qualitative content analysis was used for open-ended questions about nonusage attrition and about facilitators of and barriers to eHealth usage. RESULTS: Participants (n=561) had a mean age of 50.3 (SD 12.1) years, and most of them (340/553, 61.5%) had never visited a health care professional for SUI before. Most users were low users (295/515, 57.3%), followed by intermediate users (133/515, 25.8%) and high users (87/515, 16.9%). User groups differed significantly in age (48.3, SD 12 years; 52.1, SD 11.6 years; and 55.3, SD 10.9 years; P<.001) and in their expected ability to train the pelvic floor muscles (7.5, SD 1.4; 7.7, SD 1.4; and 8.1, SD 1.5 for low, intermediate, and high users, respectively; P=.006). Nonusage attrition was mainly caused by problems in integrating PFMT into everyday life. High age (>50 years), previous PFMT, and high expected ability to train the pelvic floor muscles are associated with high usage. Facilitators for eHealth usage were the clear explanation of exercises and the possibility of self-management. Barriers were its noncommittal character and the absence of personal contact. CONCLUSIONS: eHealth fulfills a need for women with SUI who have never received treatment. Those who discontinued prematurely did so mainly because it was difficult to integrate the training schedule into their everyday lives. High eHealth usage was more likely for women aged >50 years, with previous PFMT, and with high expectations about their ability to train the pelvic floor muscles. Knowledge of these user characteristics can guide clinicians and correct their misunderstandings about the suitable target population for this intervention. Furthermore, strategies for reinforcing expectations and self-efficacy are important to upscale eHealth usage, together with paying attention to people's need for personal contact. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/13164. CI - (c)Lotte Firet, Theodora Alberta Maria Teunissen, Rudolf Bertijn Kool, Kim Josephina Bernadette Notten, Antoinette Leonarda Maria Lagro-Janssen, Huub van der Vaart, Willem Jan Jozef Assendelft. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 17.11.2022. FAU - Firet, Lotte AU - Firet L AUID- ORCID: 0000-0001-9451-1482 AD - Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands. FAU - Teunissen, Theodora Alberta Maria AU - Teunissen TAM AUID- ORCID: 0000-0001-8510-3890 AD - Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands. FAU - Kool, Rudolf Bertijn AU - Kool RB AUID- ORCID: 0000-0003-3134-487X AD - IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands. FAU - Notten, Kim Josephina Bernadette AU - Notten KJB AUID- ORCID: 0000-0002-9107-4974 AD - Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, Netherlands. FAU - Lagro-Janssen, Antoinette Leonarda Maria AU - Lagro-Janssen ALM AUID- ORCID: 0000-0003-2339-3743 AD - Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands. FAU - van der Vaart, Huub AU - van der Vaart H AUID- ORCID: 0000-0003-0890-5368 AD - Department of Gynecology, University Medical Center Utrecht, Utrecht, Netherlands. FAU - Assendelft, Willem Jan Jozef AU - Assendelft WJJ AUID- ORCID: 0000-0002-2966-3778 AD - Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands. LA - eng PT - Journal Article PT - Observational Study DEP - 20221117 PL - Canada TA - J Med Internet Res JT - Journal of medical Internet research JID - 100959882 SB - IM MH - Female MH - Humans MH - Middle Aged MH - *Urinary Incontinence, Stress/therapy MH - Pelvic Floor/physiology MH - *Internet-Based Intervention MH - *Telemedicine MH - Exercise Therapy/methods PMC - PMC9716423 OTO - NOTNLM OT - adherence OT - eHealth OT - implementation science OT - mixed methods design OT - nonattrition OT - pelvic floor muscle training OT - urinary incontinence OT - usage OT - women COIS- Conflicts of Interest: The logo Tat is registered as trademark by EQUIPO for eContinence AB, a Swedish e-health company founded in July 2021. The authors of this paper declare no conflicts of interest, and they have no involvement in the Swedish eContinence group. EDAT- 2022/11/18 06:00 MHDA- 2022/11/22 06:00 PMCR- 2022/11/17 CRDT- 2022/11/17 14:04 PHST- 2022/04/04 00:00 [received] PHST- 2022/09/26 00:00 [accepted] PHST- 2022/06/07 00:00 [revised] PHST- 2022/11/17 14:04 [entrez] PHST- 2022/11/18 06:00 [pubmed] PHST- 2022/11/22 06:00 [medline] PHST- 2022/11/17 00:00 [pmc-release] AID - v24i11e38255 [pii] AID - 10.2196/38255 [doi] PST - epublish SO - J Med Internet Res. 2022 Nov 17;24(11):e38255. doi: 10.2196/38255.