umu.sePublications
Change search
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Women's Experiences of Internet-Based or Postal Treatment for Stress Urinary Incontinence
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
Show others and affiliations
2014 (English)In: Qualitative Health Research, ISSN 1049-7323, E-ISSN 1552-7557, Vol. 24, no 4, 484-493 p.Article in journal (Refereed) 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.

Place, publisher, year, edition, pages
2014. Vol. 24, no 4, 484-493 p.
Keyword [en]
grounded theory, health seeking, Internet, interviews, relationships, self-care, women's health
National Category
Family Medicine
Identifiers
URN: urn:nbn:se:umu:diva-90457DOI: 10.1177/1049732314524486ISI: 000333655200004OAI: oai:DiVA.org:umu-90457DiVA: diva2:733024
Available from: 2014-07-07 Created: 2014-06-23 Last updated: 2017-12-05Bibliographically approved
In thesis
1. Internet-based treatment of stress urinary incontinence: treatment outcome, patient satisfaction, and cost-effectiveness
Open this publication in new window or tab >>Internet-based treatment of stress urinary incontinence: treatment outcome, patient satisfaction, and cost-effectiveness
2014 (English)Doctoral thesis, comprehensive summary (Other academic)
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.

Place, publisher, year, edition, pages
Umeå: Umeå universitet, 2014. 86 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1621
Keyword
Stress urinary incontinence, Internet, randomised controlled trial, pelvic floor muscle training, self care, quality of life, qualitative research, cost-utility analysis, validation study
National Category
Family Medicine
Research subject
Family Medicine
Identifiers
urn:nbn:se:umu:diva-84405 (URN)978-­91-­7459-­778-­3 (ISBN)
Public defence
2014-01-31, Hörsalen Snäckan (Aulan), hus 16, ingång 6, Östersunds sjukhus, Östersund, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2014-01-10 Created: 2014-01-06 Last updated: 2015-04-29Bibliographically approved

Open Access in DiVA

No full text

Other links

Publisher's full text

Authority records BETA

Sjöström, MalinJohansson, Eva E.Samuelsson, EvaUmefjord, Goran

Search in DiVA

By author/editor
Sjöström, MalinJohansson, Eva E.Samuelsson, EvaUmefjord, Goran
By organisation
Family Medicine
In the same journal
Qualitative Health Research
Family Medicine

Search outside of DiVA

GoogleGoogle Scholar

doi
urn-nbn

Altmetric score

doi
urn-nbn
Total: 150 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf