ICS 2022: Zoom To Scale? Real World Implementation Of Online Versus In-Person Community-Based Continence Promotion

(UroToday.com) Mind Over Matter: Healthy Bowels, Healthy Bladder is a small-group behavior change intervention for women aged 50 or older who want to prevent or improve urinary incontinence (UI) or anal incontinence (AI). This is a community-based program that consists of three 2-hour sessions delivered over one month and results of this in-person program have been previously and showed a 9-fold improvement in bladder symptoms and a 4-fold improvement in bowel symptoms compared to controls.1

Statewide dissemination of Mind Over Matter was begun in 2019 but due to the COVID-19 pandemic, the program was transitioned to online delivery using Zoom in May 2020.

The aims of this program were to characterize the impact of a small-group behavior change intervention implemented in communities, on women’s UI and AI symptoms and to compare intervention impact and evaluation data when implemented in person versus virtually. Prior to completing the Mind Over Matter program, participants completed demographics, bladder and bowel symptoms, and related behaviors (pad use, pelvic floor muscle exercise frequency, care seeking). The ICIQ-UI and St. Mark’s (Vaizey) Incontinence Score (SMIS) assessed symptoms following completion, an evaluation survey and patient global ratings of satisfaction (PSQ), global perception of improvement (GPI), and estimated percent improvement (EPI) assess the program.

Between 4/2019 and 12/2021, 85 workshops were held statewide (56 in-person, 29 online), reaching 708 women (481 in-person, 227 online). Mean age of participants was (74.2±8.5); majority non-Hispanic white, had education beyond high school, were insured by Medicare and perceived themselves to be in good health. Online participants were significantly younger than those who participated in person, were more likely to live alone, have a bachelor’s or graduate, and have access to someone to help around the house when needed. No significant differences between in-person and online participants as regards race, ethnicity, marital status, urban vs. rural dwelling, health insurance type, and general health status. Urinary incontinence severity improved by one point on the ICIQ-UI for participants in both online and in-person programs. The proportion of women with mixed UI decreased from baseline to post-program among the sample overall and among in-person participants but not among online participants. There was a statistically significant improvement in AI severity by SMIS among online but not in-person participants. The amount of money spent per month on incontinence products decreased significantly from $5 to $2 in both programs but there were no significant changes in the types of products used. The proportion of participants who did pelvic floor muscle exercises routinely (often or always) was significantly higher at program completion than at baseline among both groups of participants.

The reasons cited for program participation did not differ; the most common reasons were to prevent or improve symptoms or because of liking the self-management approach. Online participants were more likely than in-person participants to attend all three Mind Over Matter sessions (p=.001). The vast majority of participants in both programs agreed that they felt comfortable in the program, thought the program was well-organized and would recommend the program to others. Online participants were significantly more likely to agree that their voice was welcomed and less likely to agree that they learned from others through program participation. But online participants were significantly less likely than in-person ones (55 vs. 63%,p=.031) to feel completely satisfied with the program. Global perception of improvement (>85%) did not differ between online and in-person participants.

In summary, the online program was more likely to reach those who live alone and have access to help around the house when they need it, and less likely to reach older women and those with a high school education or less, suggesting a role for both in-person and online programs to optimize program reach. Both program participants saw improvements in both UI and AI symptoms. Participation was motivated by the desire to prevent or improve symptoms and the program’s focus on self-management rather than recommendations from healthcare providers.

Presented by: Madeline Moureau, University of Wisconsin School of Medicine and Public Health

Written by: Diane Newman, DNP, CRNP, FAAN, BCB-PMD, Urologic Nurse Practitioner, Adjunct Professor of Urology in Surgery, Senior Research Investigator, Perelman School of Medicine, University of Pennsylvania during the International Continence Society Annual Meeting, September 7-10, 2022, Vienna, Austria.


  1. Brown HW, Braun EJ, Wise ME, et al. Small-Group, Community-Member Intervention for Urinary and Bowel Incontinence: A Randomized Controlled Trial. Obstet Gynecol. 2019;134(3):600-610. doi:10.1097/ AOG.0000000000003422 2.