Development of a Complex Intervention for the Management of Urinary Incontinence Among Community-Dwelling Older Women.

Abstract

Introduction and hypothesis: This study is aimed at developing a complex intervention that considers stakeholders' needs and preferences, as well as facilitators and barriers affecting adherence to interventions for the management of urinary incontinence among community-dwelling older women.

Methods: Following the Medical Research Council framework for developing complex interventions, this study includes two steps. In step 1, guided by the Evidence to Decision framework, qualitative interviews were conducted with stakeholders (older women with urinary incontinence and community doctors) to find out their needs and preferences regarding the intervention, as well as to identify key factors influencing the intervention adherence. In step 2, an initial draft of the complex intervention was constructed based on the information generated from the qualitative interviews. Further refinements were made through expert consultations before a final version was reached.

Results: A total of 13 older women with urinary incontinence and 14 community doctors were interviewed in the first step. Stakeholders preferred a combination of group-based pelvic floor muscle training in community activity rooms and self-directed home pelvic floor muscle training, with a frequency of 2-3 times per week. Five facilitators and five barriers affecting adherence to the intervention among community-dwelling older women with urinary incontinence were identified, and coping measures were proposed accordingly.

Conclusions: A tailored complex intervention was developed, including a core component (pelvic floor muscle training), along with six supplementary components (physical assessment, health education, reminders and supervision, group discussion, reward system, and flexible schedule).