PROJECT SUMMARY
One out of three midlife and older women suffer from urinary incontinence, a condition leading to depression,
social isolation, functional decline, and loss of ability to live independently. Although behavioral management
strategies such as bladder training and pelvic floor exercises are effective in controlling incontinence, many
women with incontinence never receive appropriate training in these first-line behavioral techniques.
Furthermore, the usual barriers to engaging in behavioral incontinence management faced by mainstream U.S
women are greatly magnified for ethnic minority women with limited English proficiency, who struggle to find
healthcare providers who can provide education or support for incontinence in languages other than English.
Our research addresses the critical lack of access to training or support for first-line behavioral management of
incontinence among ethnic minority women with limited English proficiency. Rather than relying on scarce
clinicians who combine clinical expertise in incontinence with fluency in languages other than English, we
propose to adapt an interactive, web-based, patient-facing program for behavioral incontinence management
(MyHealtheBladder) previously developed by a member of our study team. Designed for smartphones with
pictorial, written, and limited audio content, this program offers a potentially accessible, scalable platform for
providing language-concordant education and support to diverse women with incontinence in the community.
With support from the NIH Office of Research in Women’s Health, we propose to adapt this mobile health
program for women from the two largest ethnic minority groups with high rates of limited English proficiency in
the United States: Latina women whose preferred language is Spanish, and Chinese American women whose
preferred language is Chinese. We will recruit midlife and older women from these backgrounds from the
community and obtain their iterative, substantive feedback on the content and format of the mobile health
program. Based on pilot-testing of initial language-concordant program versions as well as input from local
community organizations focused on Latina and Chinese American health, we will refine program prototypes to
pave the way for future follow-up studies that can evaluate feasibility, acceptability, and eventually efficacy of
mobile health training in behavioral incontinence management in these populations.
If the adapted mobile health program is eventually found to be effective in larger-scale trials, it can be widely
disseminated by healthcare systems and community organizations to reduce the burden of incontinence
among Spanish- and Chinese-speaking women nationwide, as well as adapted for additional language and
ethnic groups in the future. As a result, this research has great potential to decrease disparities in incontinence
for demographically important groups who have been marginalized from existing systems of incontinence care.
