Optimizing remote access to Urinary Incontinence Treatments for Women Veterans: Identifying salient features of participants' experiences with two delivery modalities.

Importance and objective: Behavioral treatments are recognized as evidence-based approaches for treatment of urinary incontinence (UI) in women. However, many women do not have in-person access to qualified providers, which has led to the emergence of remote methods of delivery for behavioral treatment. The purpose of this study was to identify salient features of participants' experiences with two modalities for remote delivery of behavioral treatment for UI within a pragmatic randomized trial. Design setting and participants: Individual qualitative interviews were conducted to explore the views and experiences of women Veterans who completed behavioral treatment delivered by a mobile health application (MyHealtheBladder, MHB) or video visit via VA Video Connect (VVC). The study was conducted at 3 Southeast VA healthcare systems (April 2020 - September 2023). Interventions: MHB consisted of 56 self-administered daily sessions delivered remotely over 8 weeks. VVC consisted of a single session with a specialized UI provider. After the first 8 weeks, women identified as non-responders (based on self-reported symptom improvement) were randomized to an additional VVC session or no session. Analysis: A hybrid qualitative content analysis integrating deductive and inductive methods was conducted to identify the most frequently occurring and highly emphasized topics. Results: Of the 188 women Veterans who completed the first 8-week treatment, 41 completed the interview. Participants focused on three topics: (1) encountering technical and logistical issues in access and use; (2) interacting with the program content; and (3) finding motivation, encouragement, and inspiration. Participants in both arms of the study spoke of the importance of the structure and process of content presentation, emphasizing mechanisms for reminders, review and feedback. They also valued the woman Veterans' UI stories and provider verbal and nonverbal expressions of care and support as sources of motivation and encouragement. MHB participants reported far fewer challenges with accessing information compared to their VVC counterparts. Conclusion: Future mobile health programs should incorporate mechanisms for smooth navigation of MHB and timely provider feedback, as well as strategies to ensure patients can access VVC and are prepared for participation in ways that optimize their engagement with the behavioral treatment program.