In the context of the COVID-19 pandemic and subsequent social distancing requirements, many group education sessions provided by health care services were suspended. Continence education classes, designed to provide clients with early access to basic self-management strategies whilst awaiting first appointments, as well as reduce waiting times and non-attendance rates to initial assessments, were transitioned to telehealth. Previous case reports have suggested that telehealth may be an effective tool for the management of women experiencing incontinence (1) however research evaluating the delivery of group continence education via telehealth is limited. The aim of this review is to compare the feasibility of and client satisfaction with telehealth continence education classes to in-person continence education classes.

A retrospective audit of data from continence education classes was conducted. Data from telehealth classes which ran from July-December 2020 and in person-classes which ran from July-December 2018 were analysed. Demographic data on clients allocated to group education sessions was obtained from patient medical records. Clients were triaged to the group education sessions at the point of referral if they were female, English-speaking and did not have any co-morbidities which would prevent them from attending a class or implementing the self-management techniques provided, such as cognitive impairment. Class participants routinely provided feedback on the classes via a five-point Likert scale. with the option to include additional comments at the end of the survey. This survey was implemented within the service from December 2018. In-person class feedback surveys were taken from December 2018 to February 2019. Telehealth class survey responses from July to December 2020 classes were analysed. Engagement and attendance to telehealth classes and telehealth feedback survey responses were extracted from telehealth software. Attendance records to in-person classes were accessed from clinic scheduling software. Quantitative data were analysed using descriptive statistics. Qualitative responses to telehealth class feedback surveys were analysed thematically. The primary investigator coded and developed themes from the responses which were then cross-checked by the co-investigator. Time spent by staff to organise and conduct the classes were retrospectively estimated by staff, with comparisons to scheduled diaries and clinic statistical software used to support these estimations.

In the 2020 referral period from which clients were allocated to the telehealth classes, the service received 427 referrals and 46 clients (11%) were allocated to the telehealth classes, while in the equivalent baseline period, the service received 579 referrals and 75 clients (13%) were allocated to the in-person classes. Nine clients triaged to the telehealth class in the referral period were not allocated to the telehealth class because they had limitations with technology. The average age of clients who attended the July to December telehealth classes was 56 years of age compared to an average age of 64 years for the July to December 2018 in-person classes. The non-attendance rate for the telehealth classes was 32% (n=13) compared to 35% (n=26) for the in-person classes. 
Eight clients completed the feedback survey for the telehealth classes, with six of these clients including additional comments. Seventeen clients completed the feedback survey for the in-person class, including one client who only partially completed the survey. Seventy-three percent of survey respondents agreed or strongly agreed that it was easy to join the telehealth session. One hundred percent of respondents agreed or strongly agreed that the telehealth classes were interesting compared to 94% of respondents for the in-person classes. Key themes which arose from telehealth class participant’s additional feedback (n = 6) were difficulty with technology, presentation quality and appreciation for the content or format of the class. Participants reported having issues logging into the class and with the quality of audio-visual components of the class (“I struggled to login…”, “…I managed to lose visual but had audio”). Feedback regarding the quality of the presenter included: “wonderful approach delivering information and addressing participants”, “the presenter talks a little bit too fast” and “[it was] difficult to be focussed on the information being given”. Participants reported that they valued the telehealth format (“I would like to see more of this kind of training sessions from now on”, “everything was good”) and were grateful for the content of the sessions (“thank [siq] incontinence clinic”, “your support is greatly appreciated”). 
In order to run the classes, staff were required to contact and schedule in clients, set up the telehealth software, conduct the classes, attend to the required documentation after the class, complete clinical questionnaires with the clients and book initial assessment appointments for the clients. The amount of time spent completing these tasks was included in the following estimations. Eleven telehealth classes were conducted during July to December 2020 and an estimated total of 55 staff hours (approximately 5 hours per class) were dedicated to organising and running the classes during this time. Nine in-person classes were conducted during the 2018 period. Based on available staff diaries during this period, amount of time required by staff to conduct classes and complete associated administration was estimated to be 3 hours per class (approximately 27 total staff hours during the 2018 period).

This is the first study evaluating the feasibility of telehealth education classes for women experiencing incontinence. The percentage of referrals triaged to classes was comparable across the two time periods. Only a small portion of clients triaged to the telehealth class were unable to attend due to limitations with technology. There may be a correlation between the ages of clients who have the technological capability to attend a telehealth class as the average age of attendees to the in-person class was higher. Clients were screened for their technological capabilities prior to being booked into the class. This may account for the comparable non-attendance rates across in-person and face to face classes, as clients who may have failed to attend due to technology were not allocated to the class. Feedback for the content of the two classes was positive, however issues with technology was a key theme which emerged from the telehealth class feedback. Joining the telehealth class and issues with the audio-visual components of the session were the elements participants reported struggling with the most. Despite some reporting technical issues, other clients appeared to value the format of the class. Based on the analysis of staff diaries during the two time periods, telehealth classes may require a larger time commitment from staff compared to the in-person classes. Further evaluation and refinement of the processes associated with running telehealth classes is warranted to meet increasing financial pressures associated with delivering public health care.

Telehealth is a feasible modality for the delivery of continence education classes. Client non-attendance rates to in-person classes were similar to telehealth classes. Access to technology may be a barrier to attendance to telehealth classes for some clients. Telehealth classes may be more time consuming for clinicians.

Conlan, L., Thompson, J., & Fary, R. (2016). An exploration of the efficacy of telehealth in the assessment and management of stress urinary incontinence among women in rural locations. Australian & New Zealand Continence Journal, 22(3), 58-64. https://www.continence.org.au/health-professionals/australian-and-new-zealand-continence-journal