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Women's Experiences of Internet-Based or Postal Treatment for Stress Urinary Incontinence
Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
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2014 (Engelska)Ingår i: Qualitative Health Research, ISSN 1049-7323, E-ISSN 1552-7557, Vol. 24, nr 4, s. 484-493Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Stress urinary incontinence is common and sometimes embarrassing. New, simple, and easily accessible treatments are needed. We telephone interviewed 21 women who participated in a randomized controlled study comparing two treatment programs based on instructions for pelvic floor muscle training. One program was Internet-based and included email support by a urotherapist; the other was sent by post. There was no face-to-face contact in either program. Our main aim was to explore the women's experiences of the Internet-based treatment. Grounded theory analysis revealed three categories: hidden but present, at a distance but close, and by myself but not alone. These were incorporated in a core category: acknowledged but not exposed. The leakage was often a well-hidden secret, but the study treatments lowered the barrier for seeking care. In the Internet group, a supportive patient-provider relationship developed despite the lack of face-to-face contact. Internet-based treatment programs can increase access to care and empower women.

Ort, förlag, år, upplaga, sidor
2014. Vol. 24, nr 4, s. 484-493
Nyckelord [en]
grounded theory, health seeking, Internet, interviews, relationships, self-care, women's health
Nationell ämneskategori
Allmänmedicin
Identifikatorer
URN: urn:nbn:se:umu:diva-90457DOI: 10.1177/1049732314524486ISI: 000333655200004OAI: oai:DiVA.org:umu-90457DiVA, id: diva2:733024
Tillgänglig från: 2014-07-07 Skapad: 2014-06-23 Senast uppdaterad: 2018-06-07Bibliografiskt granskad
Ingår i avhandling
1. Internet-based treatment of stress urinary incontinence: treatment outcome, patient satisfaction, and cost-effectiveness
Öppna denna publikation i ny flik eller fönster >>Internet-based treatment of stress urinary incontinence: treatment outcome, patient satisfaction, and cost-effectiveness
2014 (Engelska)Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
Abstract [en]

Background Stress urinary incontinence (SUI) is the leakage of urine when coughing, sneezing, or on exertion. It affects 10-35% of women, and can impair quality of life (QOL). First-line treatment is pelvic floor muscle training (PFMT). However, access barriers and embarrassment may prevent women from seeking care. There is a need for new, easily accessible ways to provide treatment.

Aim To evaluate the treatment outcome, patient satisfaction, and cost-effectiveness of an Internet- based treatment programme for SUI.

Methods We recruited 250 community-dwelling women aged 18-70 years, with SUI ≥1/week via our website. Participants were randomised to 3 months of PFMT with either an Internet-based programme (n=124), or a programme sent by post (n=126). We had no-face-to face contact with the participants, but the Internet group received individually tailored e-mail support from an urotherapist. Treatment outcome was evaluated after 4 months with intention-to-treat analysis. After treatment, we telephoned a strategic selection of participants (Internet n=13, postal n=8) to interview them about their experiences, and analysed the results according to grounded theory principles. We also performed a cost-utility analysis with a 1-year societal perspective, comparing the treatment programmes with each other and with a no-treatment alternative. To scrutinize our measure of QOL, we performed a reliability study of the ICIQ-LUTSqol questionnaire.

Results Participants in both intervention groups achieved highly significant improvements (p<0.001) with large effect sizes (>0.8) in the primary outcomes symptom score (ICIQ-UI SF: mean change Internet 3.4 [SD 3.4], postal 2.9 [3.1]), and condition-specific QOL (ICIQ-LUTSqol: mean change Internet 4.8 [SD 6.1], postal 4.6 [SD 6.7]); however, the differences between the groups were not significant. Compared with the postal group, more participants in the Internet group perceived they were much or very much improved after treatment (40.9%, vs. 26.5%, p=0.01), reduced their use of incontinence aids (59.5% vs. 41.4%, p=0.02), and indicated satisfaction with the treatment programme (84.8% vs. 62.9%, p<0.001).

Results from the interviews fell into three categories: about life with SUI and barriers to seeking care; about the treatments and the patient-provider relationship; about the sense of empowerment many women experienced. A core category emerged: “Acknowledged but not exposed.”

The extra cost per quality-adjusted life year (QALY) gained through use of the Internet-based programme compared with the postal programme was €200. The extra cost per QALY for the Internet-based programme compared with no treatment was €30,935.

The condition-specific questionnaire ICIQ-LUTSqol is reliable in women with SUI, with high degrees of agreement between overall scores (Intraclass correlation coefficient 0.95, p<0.001).

Conclusion Internet-based treatment for SUI is a new, effective, and patient-appreciated treatment alternative, which can increase access to care in a sustainable way.

Ort, förlag, år, upplaga, sidor
Umeå: Umeå universitet, 2014. s. 86
Serie
Umeå University medical dissertations, ISSN 0346-6612 ; 1621
Nyckelord
Stress urinary incontinence, Internet, randomised controlled trial, pelvic floor muscle training, self care, quality of life, qualitative research, cost-utility analysis, validation study
Nationell ämneskategori
Allmänmedicin
Forskningsämne
allmänmedicin
Identifikatorer
urn:nbn:se:umu:diva-84405 (URN)978-­91-­7459-­778-­3 (ISBN)
Disputation
2014-01-31, Hörsalen Snäckan (Aulan), hus 16, ingång 6, Östersunds sjukhus, Östersund, 13:00 (Svenska)
Opponent
Handledare
Tillgänglig från: 2014-01-10 Skapad: 2014-01-06 Senast uppdaterad: 2018-06-08Bibliografiskt granskad

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