A smartphone application to support bladder training in children and adolescents with daytime urinary incontinence: Design, development, and user testing of URApp (Preprint)

BACKGROUND 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 victimisation, poor self-image, and problems with peer relationships. First line conservative treatment for UI is bladder training (standard urotherapy) which is aimed at establishing a regular fluid intake and a timed schedule of toilet visits. Success of bladder training is strongly dependent on good adherence, which can be challenging for young people. OBJECTIVE This paper describes the development of a smartphone app (URApp) which is aimed at improving adherence to bladder training in young people aged 11-20 years old. METHODS URApp was designed using participatory co-design methods and was guided by the Person-Based Approach to intervention design. Core app functions were based on clinical guidance and included setting a ‘daily drinking goal’, recording fluid intake and toilet visits, reminders to drink and go to the toilet, and recording progress towards drinking goals. The development of URApp comprised four stages: (i) review of current smartphone apps for UI; (ii) participatory co-design workshops with young people with UI to gather user requirements for the app and to develop wireframes; (iii) development of the app prototype; and (iv) user testing of the URApp prototype, qualitative interviews with 23 young people aged 10-19 years with UI and/or urgency and eight clinicians. The app functions and additional functionality to support adherence and behaviour change were iteratively optimised throughout the app development process. RESULTS Young people who tested URApp judged it to be a helpful way of supporting their adherence to a timed schedule of 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 to bladder training best practice guidelines. URApp was deemed age appropriate with all clinicians reporting they would use it within their own clinics. Clinicians felt URApp would be of particular benefit for patients whose symptoms were not improving or were not engaging with their treatment plans. CONCLUSIONS The next stage is to evaluate URApp in a range of settings including paediatric continence clinics, primary care and schools to test whether it could be an effective (and cost-effective) solution to provide personalised support for young people to improve their adherence to bladder training, and therefore reduce UI.