Effectiveness And Process Evaluation Of An APP-Based Self-Management Intervention For Maternal Urinary Incontinence

BackgroundMaternal urinary incontinence(UI)has a high prevalence and a wide range of negative effects on their lives.With the continuous development of mobile health,mobile application(APP)have been gradually applied to the management of urinary incontinence with good results,but most of the existing studies focus on middle-aged and elderly women with urinary incontinence,and there is insufficient evidence of its application in the maternal population.ObjectivesThis research will evaluate the effectiveness and process of the intervention through a multicenter trial using the "UIW" maternal urinary incontinence selfmanagement app developed by the group as an intervention tool.Methods(1)Evaluation of the effectiveness of the APP-based maternal urinary incontinence self-management interventionA quantitative study was conducted,which used a convenience sampling method to recruit pregnant women who met the inclusion criteria at five trial centres from June to September 2022 and were randomized to either the control or trial group.Urinary incontinence symptoms were used as the primary outcome indicator and quality of life for urinary incontinence as a secondary indicator.Data were collected before the intervention,12 weeks after the intervention and 6-8 weeks postpartum,and the effects were analyzed using generalized estimating equation.(2)Mechanism evaluation of a maternal urinary incontinence self-management intervention based on the MRC process evaluation frameworkA qualitative study was conducted to evaluate the mechanism dimensions of the framework using the complex intervention process evaluation framework developed by The Medical Research Council(MRC)in the UK as a guide.A convenience sample was used to select pregnant women in the trial group for semi-structured interviews and Braun&Clarke thematic analysis was used to analyze the data to explore potential pathways for intervention effects.(3)Context and implementation evaluation of a maternal urinary incontinence self-management intervention based on the MRC process evaluation frameworkA mixed study was conducted to evaluate the context and implementation dimensions using the MRC process evaluation framework as a guide.The context evaluation included investigating the accessibility of urinary incontinence services at the trial centres,researchers’ urinary incontinence practice behaviours,etc.The implementation evaluation included investigating the fidelity of intervention implementation by researchers,the study participants’ APP use log and feedback,etc.Results(1)Evaluation of the effectiveness of the APP-based maternal urinary incontinence self-management intervention295 study participants were recruited and 267 completed follow-up at all nodes.The results of the generalized estimating equation showed that the trial group was significantly lower than the control group in terms of prevalence and severity of urinary incontinence and significantly better than the control group in terms of improved quality of life in urinary incontinence(p=0.047;p=0.037;p=0.047).(2)Mechanism evaluation of a maternal urinary incontinence self-management intervention based on the MRC process evaluation framework23 pregnant women from the trial group participated in the interviews,which yielded four themes:"cognitive guidance","reliable training tools","training is for your own good",and "Training becomes a routine".The intervention improved the confidence and compliance of the pregnant women in training by correcting their misconceptions and enhancing their pelvic floor muscle training ability.(3)Context and implementation evaluation of a maternal urinary incontinence self-management intervention based on the MRC process evaluation frameworkThe researchers and the pregnant women in the trial group participated in the process evaluation,and the overall score for intervention implementation fidelity was(6.65±0.76),and the intervention was able to be implemented by the researchers as planned.Pregnant women rated the overall quality of the APP as(7.24±1.86),the ease of use as(7.56±1.89)and the usefulness as(7.42±1.81).65.3%of pregnant women indicated that they would like to continue using the APP and 66.1%indicated that they would like to recommend the APP to other pregnant women around them.ConclusionsThe effectiveness and process evaluation of the intervention showed that the APPbased maternal urinary incontinence self-management intervention was effective in reducing the prevalence of maternal urinary incontinence and improving its severity and quality of life.Pregnant women showed a high level of acceptance of the intervention and recognized its benefits.The APP-based maternal urinary incontinence self-management intervention can be effectively implemented and applied in multiple centres.