Scripties UMCG - Rijksuniversiteit Groningen
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Implementation and Optimisation of Self-Management eHealth Treatment for Women with Mild to Moderate Urinary Incontinence, in Order to Evaluate the Usability of the ICT System and to Analyse its Technical Specifications and Functionalities

(2017) Vodegel, E. (Eva)

Background: Urinary incontinence is a common problem among women. In particular, stress urinary incontinence can lead to women stopping to participate in physical exercises and social activities, negatively affecting her confidence, self-perception and overall quality of life. Conservative treatment consists of pelvic floor muscle therapy and lifestyle interventions. However, one of the main problems is that the adherence to treatment is low. eHealth could play an important role in the solution for this problem. Therefore, the WomenUp consortium has developed an innovative self-management ICT system. With the use of biofeedback and interactive training games on a mobile application, it is aimed to improve pelvic floor training in terms of adherence and quality. Patients are remotely supervised by a therapist via an online platform, where results are uploaded and where patients can interact with their therapist. This self-management treatment for urinary incontinence will be compared to usual care with PFMT in terms of clinical, economical and satisfactory outcomes in a randomised controlled trial. Prior to this, it is of great importance to evaluate the implementation and usability of the self-management ICT system first, and to explore barriers experienced by women while using the system.
Objective: This pilot study aimed to evaluate the usability of the WomenUp self-management system, and analyse its technical specifications, functionalities and ease of use.
Methods: Nine women (two patients with urinary incontinence, seven volunteers) from Barcelona, Amsterdam and Kuopio have tested the WomenUp self-management system in different evaluation cycles, during a period of two weeks. Prior to the testing period, an individual intake visit took place. The self-management system was handed over to the subject and a she was asked to fulfil a short pelvic floor training exercise. During this task, a think-aloud method was used. Thereafter, subjects received instructions about the proper use of the self-management system. After the testing period, each subject completed an evaluation questionnaire. During a final meeting, subjects were asked to perform an exercise with the system, using a think-aloud method. Thereafter, a semi-structured interview was conducted with the focus on the subjects’ experiences and barriers that were faced when using the system. Also, the experiences of the involving therapists were evaluated. Each therapist completed an evaluation questionnaire, performed a small task on the platform, while a think-aloud method was used and a semi-structured interview was conducted. Data was analysed using a thematic data analysis method. MAXQDA (version 12.2.1) software was used to do a computer-assisted qualitative data analysis.
Results: This pilot study performed an extensive evaluation of the usability of the WomenUp self-management ICT system and explored barriers in addition. Users rated the system as easy in use and liked the way to train their pelvic floor. They experienced that pelvic floor exercises became more fun to do. However, participants responded that a report of progress and more constructive feedback after the training games were preferred. Also, some technical issues arose, as system bugs and broken cables. The participants reported various suggestions to further improve the system and to make the training games more interactive and challenging.
Conclusion: Overall, this pilot study provided great insight into the usability of the WomenUp self-management system and is of great value to improve and further develop this system. Hereby, the needs of the users will be taken into account for better optimisation, with respect to its acceptability and utility. Although the results of this pilot study were promising, technical issues and shortcomings of the system appeared. This addressed that it was essential to evaluate the WomenUp self-management system prior to its use in a randomised controlled clinical trial.

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