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Innovations in Incontinence EducationKay Hogan-Smith1; Brian F. Geiger 2; Marcia R. O’Neal3; Mary Alice Gillispie4; David W. Coombs5; & Laura Talbott3

1UAB Lister Hill Library of the Health Sciences; 2The Horizons School; 3UAB School of Education and Center for Educational Accountability; 4Healthy Roads Media; 5UAB School of Public Health

INTRODUCTION

Researchers produced and piloted brief consumer educational modules for older adults,

building on knowledge gained from review of literature, surveys conducted at senior health

fairs, and guidance from an expert panel of advisors.

EXPECTED OUTCOMES

1. Promote aging in place through effective support for community-dwelling older adults

who experience incontinence and their caregivers.

2. Teach older adults specific skills, such as physician communication; monitoring and

reporting frequency of urination, daily medication, and dietary habits; & training pelvic

floor muscles.

3. Disseminate health information in several formats and in two languages to reach a wide

audience of older adults in the Birmingham-Hoover (AL) Metro Area.

THEORETICAL BASIS AND METHODS

DISCUSSION AND RECOMMENDATIONS

Contact Kay Hogan-Smith, MLS, MPH, CHES; Brian F. Geiger, EdD, FAAHE; Marcia O’Neal,

PhD; Mary Alice Gillispie, MD; David Coombs, PhD, MPH; Laura Talbott, PhD, MCHES.khogan@uab.edu, bgeiger@horizonsschool.org, moneal@uab.edu , magillispie@healthyroadsmedia.org,

dcoombs@uab.edu, ltalbott@uab.edu.

Support provided by UAB, National Network of Libraries of Medicine, Jefferson County (AL) OSCS, and Astellas

Pharma.

RESULTS

• Researchers used Rogers Diffusion of Innovation theory to develop and disseminate

innovative modules educating seniors about bladder incontinence.

• Content was informed by:

• NIH State of Science Conference Statement: Prevention of Fecal and Urinary Incontinence

in Adults (2007).

• Abrams P. Committee 12: Adult conservative management. In: Incontinence: 4th

International Consultation on Incontinence. Paris: Health Publications Ltd.; 2009:1027-8.

• Incontinence webinar for consumers, hosted by AUA Foundation.

• Urology experts from UAB School of Medicine, Birmingham VAMC, and University of

Pennsylvania.

• Designed modules of 5 minutes or less, with a reading level at or below 9th grade.

• Modules are available without cost in several formats (narrated video tutorials, audio-only

or printed files). Minimal computer skills are required.

• Consumers access modules online through healthyroadsmedia.org, as smart phone

applications, or as media files stored on CD or flash drive.

• Researchers conducted presentations in 19 area senior nutrition and activity centers and

other locations.

• Four objectives guided outreach activities:

1) demonstrate how to access modules and use printed materials,

2) engage seniors who may have incontinence to use module content and seek treatment,

3) recommend reliable consumer health resources, and

4) obtain user feedback on content of modules.

ACCESS INNOVATIONS

• Modules may be downloaded as MP4 files and as smart phone apps, with transcripts and

related handouts.

• Materials were provided to senior center managers on CDs and flash drives and as Plain

Language illustrated handouts for dissemination.

• To increase consumer access and use, developers carefully refined English and Spanish

language content through multiple reviews. Considerations included reading level, message

complexity, length and use of familiar terms.

• Spanish translations of modules were completed by bilingual team members and tested at

a multicultural resource center with 10 participants. Only minor edits were recommended

to increase clarity of messages and add images of diversity in modules 2 & 3.

• There is value in a systematic approach to develop and test new materials for consumer health

education.

• Older adults may feel uncomfortable about discussing bladder health and seeking treatment.

• Collaboration is key, requiring building trust among team members and community partners.

• Keep modules short and simple, e.g., 3-5 minutes. Use Plain Language.

• Increasing awareness among consumers requires multiple modes of access and communication.

• Plan in advance; some community agencies lack equipment and Internet access.

• Older adults may use online materials in public libraries, churches, senior nutrition and activity

centers.

• Older adults may resist a complicated consent process; simplify when possible.

• Modules developed will be disseminated to medical students nationwide as part of a geriatric

education unit.

Table 2. Older Adults’ Ratings of Media

Rating Item Module 1(N=91)

Module 2(N=158)

Module 3(N=131)

1. Module length? (% responding Just Right) 84.4% 95.8% 87.7%

2. Information Clarity? (% responding Very Clear) 78.8% 80.7% 81.0%

3. Helpfulness of incontinence information?(% responding Very Helpful)

68.4% 82.8% 75.4%

4. Will this module help people talk to their doctor about incontinence? (% responding Yes)

96.7% 98.7% 100.0%

5. Does the written script help you understand the information? (% responding Yes)

96.6% 98.0% 100.0%

6. Will you share this module with a friend or relative? (% responding Yes)

94.3% 95.5% 96.8%

7. Do the pictures in the module help you understand the information? (% responding Yes)

93.4% 97.4% 93.1%

• Researchers presented continence education to 300 older adults and 20 caregivers in community

settings; 81% of participants were female; 47% Black, 50% White, & 3% other.

• 380 anonymous responses to rating forms were completed after viewing one or more modules.

Items included 7 objective and 5 open-ended.

• Results revealed 90% felt module length was Just Right, 80% felt modules were Very Clear, and

77% perceived content to be Very Helpful (see Table 1).

• In addition, 99% believed modules will help adults talk to doctors about incontinence;

98% agreed that handouts helped to understand information; 96% agreed that images helped

them understand content; and 95% planned to share modules with others.

Module Title Downloads 2011 – Present

Total Downloads by Language*

1 – Basics About Incontinence

3,004 English = 5,555Spanish = 3,891

2 – Help for Incontinence

3,502

3 – Early Diagnosis & Managing Symptoms 2,940

SUM

9,446 9,446

Table 1. Number of Media Downloads by Title & Language

Most users preferred to view narrated modules on the web (6,298). Other requested formats

included audio only files (1,132 downloads), illustrated handouts (1,436 downloads) and

mobile/smart phone apps (580 downloads). (*The Spanish language version of Module 3 has

been downloaded more frequently than the English version.) In addition, media were

provided to senior nutrition and activity center directors on CDs and flash drives and as Plain

Language illustrated handouts for wider dissemination to older adult members.

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