Urgency Urinary Incontinence (UUI) has a significant cost and impact on quality of life in the older population. Prior research reveals up to 40% of episodes of UUI are provoked by encounters with situational triggers such as approaching the front door (“latchkey incontinence”) or encountering running water. Our recent study examined the impact of novel non-pharmacological methods of reducing situationally provoked urgency urinary incontinence: exposure to personally created photographic urgency triggers (e.g., photos of one’s own front door, kitchen sink) while engaging in brief mindfulness (MI), transcranial direct current stimulation (tDCS) of the brain (dorsolateral prefrontal cortex), or both simultaneously, to attenuate the effect of these external stimuli. Given the novelty and time commitment of the study (i.e., 7 sessions over 4 weeks with daily bladder diaries) we sought to examine the acceptability of these interventions in those participating in these interventions.
Using an anonymous post-treatment survey, we assessed overall study acceptability and individual intervention acceptability. Here we present the reported acceptability of these non-invasive interventions to reduce situationally triggered urinary urgency.

Study Design: Women 40 years of age and older, with situationally triggered urgency or incontinence, were randomized to receive one of three therapeutic interventions: Mindfulness only (MI), tDCS only (tDCS), and Mindfulness + tDCS (MI + tDCS), to be practiced during exposure to personalized visual trigger scenarios. All participants completed 7 sessions in total: an enrollment session with homework to take personal photographs to use as cue images, a baseline assessment of reactivity to cues, 4 training sessions (20 minutes of cue exposure with intervention), a post-therapy assessment and 20 days of daily bladder diary entries. 
Acceptability Assessment: All participants were given an anonymous mail-in survey when the study concluded. Acceptability was measured with 4-items on a 0-100 linear numeric Likert scale divided in tenths with 0 being “do not agree”, 50 being “moderately agree” and 100 being “strongly agree.” The threshold for ‘acceptable’ was set at greater than a score of 50 prior to the beginning of the study. Overall Acceptability was assessed as the mean of response to two items: “overall, I liked participating in the study” and “the time I spent was worth what I got out of treatment”. Overall acceptability was compared within treatment groups using ANOVA. Individual Intervention Acceptability was assessed with one item each “I liked the mindfulness component of this study” and “I didn’t mind the tDCS brain stimulation”. Individual acceptability of MI and tDCS was compared using a t-test.

Sixty women completed the study. Eighty-seven percent of participants (52/60) returned the anonymous survey. Overall acceptability, a mean of the two overall acceptability questions (scored 0-100), was high (see Table 1), and ANOVA revealed no differences as a function of treatment group F(2,49) = 0.196 (p=0.311). Individual intervention acceptability, the score (0-100) of a question about each individual intervention, was also high for both MI and tDCS. A significant difference was revealed, such that those receiving MI (in both the MI and MI+tDCS groups, n=36) rated intervention acceptability higher than those receiving tDCS (tDCS and MI+tDCS groups, n=36) with a mean(SD) = 90.6(14.5) vs 74.1(29.9) (t-test: p=0.004, see Figure 1).

There was a high acceptability of both the individual interventions and the overall study, with all scores exceeding our threshold of 50. There was no difference in overall acceptability between any of the three interventions, but participants rated mindfulness as significantly more acceptable than tDCS. Considering the overall burden of the study which included: selecting and photographing urgency triggers, 14-24 days of bladder diaries, seven in-person visits with 4 consecutive training days and daily home mindfulness practice for the MI groups, the acceptability scores reflect the positive experience of the participants in this study.

These non-pharmacological interventions were extremely acceptable to the study population, despite the high participant burden of the study. Although the participants preferred mindfulness to tDCS brain stimulation, tDCS still had an acceptability score well above our anticipated threshold. These techniques seem to be acceptable, novel treatments for situational UUI in older women as a non-pharmacological way to attenuate situational urgency triggers.