Despite the increasing availability of digital health interventions, few solutions have been co‑designed with professionals and end‑users. Co‑design is essential to ensure that digital tools are clinically relevant as well as meaningful, usable and engaging for the people who will rely on them. This study explored the preferences of end‑users, healthcare professionals and experts to inform the design of a digital solution for promoting bladder health in people aged 50 and over. Specifically, it sought to identify essential features, barriers, facilitators and behaviour‑change components required to optimise engagement and ensure clinical relevance.

A qualitative study was conducted using 8 semi‑structured online interviews with experts as well as 7 face-to-face and online focus groups with 31 potential users aged 50+ (including 1 technology expert and 1 representative from an incontinence patient association) and 15 healthcare professionals across Spain, Lithuania and the United Kingdom. The guides explored experiences with existing apps, expectations for digital tools, essential components, gamification, perceived barriers and elements to enhance adherence. All sessions were audio‑recorded, transcribed verbatim and analysed using Braun and Clarke’s reflexive thematic analysis. Themes were developed iteratively and triangulated across groups to ensure credibility and depth.

The qualitative analysis (Figure 1) revealed broad consensus regarding the limitations and opportunities of mobile applications for the management of urinary incontinence (UI). Many existing solutions were perceived as lacking clinical depth, meaningful personalisation and adequate usability for this age group. The absence of clearly evidence‑based content and visible professional endorsement was identified as a factor that undermines trust, credibility and, consequently, long‑term adherence. 

Personalisation emerged as a central expectation. Users valued applications that could adapt to their physical abilities, the type and severity of UI, and their individual progress, as well as prove quantitative monitoring of progress over time. Multimedia guidance, including visual instructions, audio cues and interactive formats, was considered essential for enhancing understanding, precision and safety during exercise performance. Behaviour‑change techniques were identified as key elements for sustaining adherence. The most relevant included goal‑setting, self‑monitoring, continuous feedback and reminders. Gamification was viewed as a promising strategy, provided it is meaningfully linked to real indicators of progress rather than superficial elements. 

Data security and digital ethics were regarded as indispensable conditions for the acceptability of any technological solution, particularly given the sensitivity of UI‑related information. Despite recognising the potential of digital tools, several barriers were identified, including stigma, low digital literacy and fear of performing exercises incorrectly. To address these challenges, participants proposed strategies such as simplified onboarding processes, explicit validation from healthcare professionals and adaptive support mechanisms that accompany users over time.

The findings align with previous research showing that many UI applications lack adequate personalisation and professional oversight, factors that reduce users’ trust and adherence. Existing literature on digital pelvic-floor and bladder‑health interventions also highlights the need for evidence‑based content, adaptive programmes and appropriate monitoring systems. Similarly, the importance of integrating behaviour‑change techniques is well established as a determinant of sustained engagement in digital health interventions. The barriers identified are common in older populations and in conditions considered sensitive. Overall, the findings reinforce existing evidence that co‑design approaches can enhance the relevance, usability and acceptability of digital solutions.

This study identifies key elements that should guide the co‑design of a digital solution for UI management. Clinical credibility, personalisation, behaviour‑change techniques and multimedia guidance emerge as essential to build trust, support adherence and ensure safe use. The barriers identified (such as stigma or low digital literacy) highlight the need for an accessible design validated by professionals.

Mobile technologies and websites that include behaviour change techniques and elements of gamification for self-management of bladder health and/or urinary incontinence in adults aged 50 and over: a rapid review; Aguila-Gimeno O, Gasteiger N, Stanmore E, Brazaitis M, Solianik R, Karkauskiene E, Jarutiene L, Romeu Busquets J, Jerez-Roig J; 2025; JMIR mHealth and uHealth (submitted preprint); 10.2196/preprints.76867
Factors influencing seniors' acceptance of technology for ageing in place in the post-implementation stage: a literature review; Tsertsidis A, Kolkowska E, Hedström K; 2019; International Journal of Medical Informatics; 10.1016/j.ijmedinf.2019.06.027
Reflecting on reflexive thematic analysis; V, Clarke V. Qualitative Research in Sport, Exercise and Health 2019;11:589–97.