The Department of Veterans Affairs Integrated Service Network (VISN-7) is our targeted region for this
proposal, named “Improving Primary Care Understanding of Resources and Screening for Urinary
Incontinence to Enhance Treatment (PURSUIT)” as part of the Improving Nonsurgical Treatment of Urinary
Incontinence among women in Primary Care (INTUIT-PC). Our overarching goal is to improve access to
evidence-based nonsurgical UI treatment for women Veterans using the most effective remote delivery
modality in the Southeast region of the U.S. In our first aim, we will compare two models: our mHealth UI
modality alone and our mHealth UI model combined with clinician expertise delivered via clinical video
telehealth (CVT) to improve UI symptoms at the patient level. With leverage from our current clinical trial
infrastructure that utilizes these two models, our proposed study will incorporate a sequential, multiple
assignment, randomized trial (SMART) design to determine the optimal model for remote delivery of
nonsurgical UI treatment for UI symptom improvement. In our second aim, we propose an implementation
strategy of practice facilitation, to improve awareness and adherence to evidence-based guidelines on
nonsurgical UI treatments at the practice level. We will employ a Type 1 Hybrid Effectiveness-Implementation
design to assess the effectiveness of our mHealth intervention, while using the Reach, Efficacy/effectiveness,
Adoption, Implementation, and Maintenance (RE-AIM) framework to guide our practice level implementation
approach. For our third mixed-methodology aim, we seek to explore women Veterans’ and providers’
perceptions of key factors that may influence future remote UI treatment scalability for local, regional, and
national dissemination. PURSUIT aims to target 62 primary care practices that treat over 50,000 women
Veterans. Practices will be randomized in clusters to receive the interactive mHealth UI application non-
surgical UI treatment modality with or without additional clinical UI expertise delivered via telehealth. All
primary care practices will receive practice facilitation with a PURSUIT toolkit that includes (1) 1-2 visits with a
practice facilitator engaging practices through virtual group sessions and one on-site visit (if allowed); (2)
Mobile-health or mHealth Application Training (MAT) training: MAT training will be offered through in-person
academic detailing, online resources, and ongoing support via email or office hours with project staff and
experts; 3) Online Resource Hub: The online resource hub will be available throughout project implementation,
and e-learning modules will serve as the structural base for virtual practice facilitation sessions; and (4) Health
information technology (HIT) assistance: Project staff will offer support in developing UI registries for
population management, quality improvement, and data reporting through the mHealth nonsurgical UI
application. Our future goal is to disseminate the most effective modality for delivering nonsurgical UI treatment
for women Veterans nationally within the Veterans Healthcare Administration.
