Group-based education (GBE) is an emerging model used by a range of disciplines in healthcare especially to support chronic disease self-management(1–4). GBE provides knowledge and its application in daily life. It empowers patients by reducing their feelings of stigmata and isolation and provides the opportunity to meet others in similar circumstances, learn from them, and develop self-awareness. 
We introduced GBE in the pelvic floor unit for patients with defaecatory difficulties where the aim was to educate patients about these disorders and their management, improve patient care by reducing waiting times and allow patients to have access to multi-disciplinary services such as dieticians, physiotherapists, and bowel specialist nurses in one session. Evidence regarding patient experience of GBE sessions for symptoms of defaecatory difficulties is lacking. We share our experience of GBE and patient feedback.

GBE sessions were held bi-monthly and were offered both in person and online via Microsoft Teams. The sessions included talks by a bowel specialist nurse, Gastrointestinal dietician and pelvic physiotherapist. The bowel specialist nurse educated patients on symptoms of defaecatory disorders, and their first-line management which included dietary advice, bladder and bowel retraining, biofeedback, rectal irrigation and pharmacological therapy. Pelvic physiotherapists discussed the importance of performing pelvic floor exercises (PFE). Participants were shown how to perform PFE and relevant important information about websites and applications available was also provided. The dietician gave an overview about the gut-brain axis, dietary advice, and foods to avoid for managing symptoms better. The talks were interactive and included a question-and-answer session along with discussion among the patients and facilitators. Patients also shared their personal experiences including the impact on quality of life. Patient feedback was collected at the end (paper form or online survey monkey questionnaire).

The mean wait time for biofeedback after initial triage telephone appointment was reduced from a median of 4 to 1 month (p-value <0.001) with the introduction of GBE and biofeedback appointments on the same day. In total, 57 patients completed the feedback questionnaire between April 2023 and April 2024. 84% of patients felt the session was useful or very useful, 89% found the session easy to attend, and 58% felt better able to manage their symptoms following the session. 82% of patients would recommend the session to their family and friends, and 77% felt it was helpful to attend a session with patients experiencing the same symptoms.

As per patient feedback, GBE provided a safe community where participants were able to talk about taboo subjects with ease and comfort. Interaction and discussion about personal experiences allowed patients to feel that they were ‘not alone’. GBE sessions allowed patients to gain knowledge and interact with others which provided the opportunity to gain self-awareness and learn from each other’s experiences. Listening to each other and self-reflection motivated them to seek treatment. Ability to attend virtually contributed to an increase in participation for patients such as those with social anxiety, having mobility issues, or feeling embarrassed due to symptoms such as anal incontinence. Offering multi-disciplinary service on the day resulted in patients getting a comprehensive management plan and reduced the need for multi-departmental referrals and multiple future appointment visits for the patients.

With advanced planning, GBE can be a useful and a patient-centered tool to educate patients about symptoms of defaecatory disorders and their management. GBE can help reduce waiting time for patients to initiate treatment and allow better utilization of scarce healthcare resources. This can be a one-stop session where the patients interact with a pelvic physiotherapist, GI dietician, and bowel specialist nurses and also have their biofeedback appointment on the same day.

Sarkadi A, Rosenqvist U. Experience-based group education in Type 2 diabetes: A randomised controlled trial. Patient Education and Counseling. 2004 Jun 1;53(3):291–8.
Fernandes ACNL, Palacios-Ceña D, Hay-Smith J, Pena CC, Sidou MF, de Alencar AL, et al. Women report sustained benefits from attending group-based education about pelvic floor muscles: a longitudinal qualitative study. Journal of Physiotherapy. 2021 Jul 1;67(3):210–6.
Griffiths F, Pepper J, Jørstad-Stein EC, Smith JF, Hill L, Lamb S (Sallie) E. Group versus individual sessions delivered by a physiotherapist for female urinary incontinence: an interview study with women attending group sessions nested within a randomised controlled trial. BMC Women’s Health. 2009 Sep 10;9(1):25.