In the digital era, thinking about alternatives to offer educational information can promote access and adherence to forms of treatment for urinary incontinence (UI). Considering the lack of access of the majority of the population to first-line treatment, the objective of this study was to evaluate the effects of a Remote Health Education Program, on knowledge about UI, improvements in urinary symptoms, and severity in incontinent women.

Controlled, single-blind, randomized clinical trial with parallel group design. The project was approved by the Research Ethics Committee of the University of Pernambuco (UPE). The project was registered on the Brazilian Clinical Trials Registry platform under number: U1111-1231-9711, and written by the recommendations of the Consolidated Standards of Reporting Trials (CONSORT).
Women were included with complaints of urinary loss, over 18 years of age, who did not report or present any psychiatric disorder, cognitive deficit, neurological or disabling diseases, who were not pregnant or had last given birth less than a year ago, and who had not undergone previous surgery for UI correction in the last five years, who had never undergone pelvic floor muscle training (PFMT), who knew how to read, write, and understand the Portuguese language, and who had WhatsApp and internet access.
The randomization was generated by a researcher not involved in the screening and interviews, using the website http://www.randomizer.org. The allocation process was carried out using opaque envelopes, in which randomization occurred at the end of the application of the instruments, through a hidden sequence.
The randomization and allocation of volunteers were carried out into 2 groups: the Control Group (CG) and the Experimental Group (GE). The volunteers allocated to the CG received an explanatory folder about UI, while the volunteers allocated to the GE participated in the Remote Health Education Program and received, in addition to the explanatory folder, educational videos about UI.
Additionally, an outcome assessor was blinded, who was blind to randomization, allocation of participants into their respective groups, execution of the Remote Health Education Program, data tabulation, and statistical analysis.
The volunteers allocated to the GE participated in a weekly educational activity by sending videos via WhatsApp lasting 1 to 4 minutes, for a month, totaling 4 weeks of intervention.
The volunteers were evaluated before and after the intervention. The instruments used were: The prolapse and Incontinence Knowledge Quiz (PIKQ), the International Consultation Incontinence Questionnaire - ICIQ-SF, and the Incontinence Severity Index (ISI).
The sample size calculation was based on the ability to detect significant interaction effects within the mixed models using the following criteria: small effect size = 0.23; alpha= 5%; power= 90%; two groups; two assessments. The present proposal foresees a minimum number of 46 individuals (23 per group).
The data were analyzed using the Jamovi program. For the variables knowledge, urinary symptoms, and severity, mixed linear models were used for intergroup and interaction comparisons, as well as Bonferroni post-hoc for multiple comparison adjustments. Analyzes were performed following the intention to treat. The Confidence Index of 95% and p-value <0.05 were adopted.

A total of 124 participants expressed interest in participating in the study, of which 49 were excluded because they did not meet the inclusion criteria and 75 women were considered eligible. Of these, 39 women were allocated to the CG, and 26 women were allocated to the EG. Of the total number of women in the EG, two dropped out over the four weeks of intervention, and in the end, there were seven losses in the CG and three losses in the EG.
In the sample studied, in both groups, brown skin color was prevalent, with 45.3% (n=34), married or in a stable union, representing 68% of the sample (n= 51) and with an average age of 44.02 ± 11.27 in the CG and 41.75 ± 9.21 in the EG.
In the Generalized Mixed Regression Model, no difference was observed between the groups or interaction concerning PIKQ, ICIQ-SF, and severity. There was no significant difference in the PIKQ or changes in post-intervention scores. However, there was a high level of knowledge about the topic from the baseline in both groups (Table 1).

Our study showed that participating in a health education program through educational videos did not result in an improvement in urinary symptoms and severity in both groups, compared to the use of an educational folder. Although we observed a minimal reduction in ICIQ and ISI scores before and after the intervention, no important clinical difference was found.
The women had a high level of education, especially those allocated to the CG, in which the majority had postgraduate degrees, reflecting the monthly income of this group, with amounts above five minimum wages. This fact may justify the high scores on the PIKQ when evaluating knowledge about UI in the baseline data, observed in both groups which may have interfered with the results of our study.
The results of our study may be related to the fact that there were no face-to-face assessments to verify whether women had the ability to correctly contract PAM, which is an important characteristic for PFMT to be effective.
The majority of women allocated to the GE did not show interest throughout the implementation of the intervention. It was observed, due to the little interaction and reports from the volunteers in the WhatsApp group, that there was no commitment to watching the educational videos, generating doubts regarding adherence and attendance in carrying out the guided training protocol.

A Remote Health Education Program using educational videos via WhatsApp compared to sending an explanatory folder did not show a significant difference in knowledge about UI, or a reduction in urinary loss and severity.

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