Study design, materials and methods
We invited women age >50 years with urinary (UI) and/or fecal incontinence (FI), identified via the 2016 population-based Survey of the Health of Wisconsin (SHOW)(1), to participate in a 30-minute semi-structured phone interview. We mailed interview questions along with a description of 3 intervention formats, all assumed to be equally effective: (a) small-group 3-session workshop series; (b) single in-person lecture; (c) online program. Women described how and why they ranked each format in phone interviews. Verbatim transcripts were analyzed with grounded theory, a systematic, iterative inductive method.
Among 243 women in SHOW with UI or FI, 41 women were mailed invitational letters for this qualitative study; 31 were reached by phone and 23 (56%) participated. Median age was 67 (51-93 years); 21 (91%) were non-Hispanic White; 10 (43%) were college-educated. Twelve (52%) had UI & FI; 10 (43%) had UI only; 1 (4%) had FI only. When asked about usual sources for health information, 15 (65%) used the internet, 11 (48%) print materials, 8 (35%) healthcare providers, and 5 (22%) television; 17 (74%) had participated in other health education interventions. Intervention format preferences are outlined in Table 1. Additional participant quotes describing potential benefits and drawbacks of each format are outlined in Table 2.
Those who preferred an online format were younger and less bothered by symptoms. They valued information over skill-building, convenience over accountability, privacy over community, and self-directed over guided learning. “I'm extremely private…I could do it on my own time… and study what needs to be done…The only drawback would be the motivation to sit down and do it.” Barriers were lack of internet access or skills, accountability and personal touch.
Those who preferred the workshop series were motivated by high symptom distress and a desire for skill-building and social interaction. They valued accountability over convenience, community over privacy, and experiential over passive learning. “Hands-on is a really good way to go about teaching women how to deal with or change these things.” Barriers were inconvenience, lack of privacy, stigma, and shy disposition.
Those who preferred the single lecture were older and valued auditory information and handouts, time/convenience over accountability and guided over self-directed or experiential learning. “I’d rather just do one and done, though I might get more from the workshop.” Many suggested adding components of the workshop series, such as a question-and-answer or small-group breakout sessions, to the lecture.
Interpretation of results
Similar values emerged in these qualitative interviews, regardless of women's intervention format preferences. Convenience and privacy were perceived advantages of the online format and single lecture formats, whereas accountability and community were advantages of the workshop format. Symptom severity influenced women's perceptions of which format best met their needs.
Values that impact women’s preferences for continence self-management intervention formats include convenience, privacy, accountability, community, and learning style. These values should be considered in future intervention development, adaptation, dissemination and implementation efforts.