Childhood bed wetting (nocturnal enuresis) remains a sensitive and often under-reported condition in many African settings, commonly associated with shame, stigma, and silence. Children experiencing bed wetting often struggle to openly discuss their experiences, limiting both clinical understanding and research quality (1).  
Traditional interview-based approaches frequently fail to capture children’s perspectives due to power imbalances, emotional discomfort, and limited verbal expression, particularly on sensitive issues such as incontinence. There is a growing need for child-centered, participatory, and culturally responsive approaches that enable children to express themselves safely and meaningfully (2). 
This study re-imagines how children’s voices can be effectively engaged through creative and gamified participatory methods.

An exploratory qualitative participatory design was employed, involving children aged 8–12 years with lived experiences of bedwetting as primary participants. Using purposive sampling, children were recruited from community and clinical settings. Ethical approval was obtained (KATH/IRB/AP/164/25). Written informed consent was obtained from parents or guardians prior to recruitment, followed by age-appropriate assent from the children, ensuring voluntary participation and understanding of the study. Data were collected between October and December 2025 through interactive participatory sessions titled “Draw It, Show It, Talk About It”, alongside child-friendly interviews conducted in safe, private environments or via supervised virtual platforms (Zoom/Microsoft Teams). Creative methods included drawing, sticker-based gamification, storytelling, photovoice, and picture-based elicitation techniques. These approaches allowed children to express their experiences in non-threatening and developmentally appropriate ways. Data were audio-recorded, transcribed, and analysed using Braun and Clarke’s (3) reflexive thematic analysis.

Four themes illustrate how participatory approaches transform engagement among children aged 8–12 years experiencing bedwetting.

Power Imbalances and Researcher–Child Dynamics:
Children initially felt intimidated and reluctant to speak. Kojo (10 years): “When they ask too many questions, I get scared and keep quiet.” Amina (9 years): “I didn’t want to talk about it because it is shameful.” These accounts highlight how fear and adult dominance suppress children’s voices.

Creative Expression as Children’s Language:
Drawing and visual tools enabled children to communicate beyond words. Yaw (11 years): “I drew my bed and the water… that is how I feel.” Zainab (8 years): “I can show it better than saying it.” Creative expression served as a safe and meaningful communication medium.

Gamification and Visual Methods as Engagement Catalysts:
Play-based strategies increased comfort and participation. Kwame (10 years): “I like the stickers; it feels like a game.” Fatima (9 years): “When we play, I can talk freely.” Gamification reduced anxiety and encouraged openness.

Safe Spaces and Digital Flexibility:
Private and flexible environments enhanced disclosure. Kofi (12 years): “Talking on the phone is easier; no one is watching me.” Aisha (11 years): “I feel free to talk when I am alone.” Safe spaces promoted trust and psychological comfort.

In conclusion, Child-centred participatory approaches significantly enhance engagement and data quality in sensitive research areas such as bedwetting. These methods empower children to express their experiences authentically.Integrate creative, play-based methods into paediatric continence care and research. Strengthen ethical practices by ensuring robust consent and assent processes. Develop structured child-centred research frameworks for African contexts.

Lauters, R. A., Garcia, K. W., & Arnold, J. J. (2022). Enuresis in Children: Common Questions and Answers. American family physician, 106(5), 549–556
UNICEF. [2024]. Child-centred research and participation guidelines. UNICEF
Braun V., Clarke V.  2024. “Supporting Best Practice in Reflexive Thematic Analysis Reporting in Palliative Medicine: A Review of Published Research and Introduction to the Reflexive Thematic Analysis Reporting Guidelines (RTARG).” Palliative Medicine  38:608–16. 10.1177/02692163241234800

Continence 19S (2026) 102611
DOI: 10.1016/j.cont.2026.102611