Continence Across Continents To Upend Stigma and Dependency (CACTUS-D): study protocol for a cluster randomized controlled trial

Translation, cross-cultural adaptation, and measurement properties of the prolapse and incontinence knowledge quiz (PIKQ-Br) for Brazilian women with urinary incontinence

BACKGROUND

The Prolapse and Incontinence Knowledge Quiz (PIKQ) was developed to assess women's knowledge of pelvic organ prolapse (POP) and urinary incontinence (UI).

OBJECTIVE

To perform the translation, cross-cultural adaptation, and measurement properties of the PIKQ for Brazilian women with UI (PIKQ-Br).

METHODS

The measurement properties were tested for validity (content and face, structural, and hypotheses testing) and reliability (internal consistency, test-retest, and measurement error) in 130 women with UI from Recife, Brazil. Hypotheses testing for construct validity was assessed by Spearman's correlation coefficients. The standard error of measurement and the smallest detectable change were used to determine the measurement error. The structural validity was examined using a confirmatory factor analysis. Test-retest reliability and internal consistency were determined using the intraclass correlation coefficient (ICC) and Cronbach's alpha.

RESULTS

The structural validity was analyzed with a single factor and 12 questions, revealing the goodness-of-fit was inappropriate (TLI=0.60; RMSEA=0.07). The two factors and 10-question version presented adequate values and factor loading (>0.30), except questions 1, 7, and 8 in PIKQ-POP. Positive and moderate correlations for hypotheses testing were observed for PIKQ-UI-10 (rho=0.439). Positive and weak correlations were observed for PIKQ-POP-10 (rho=0.278). Cronbach's alpha coefficients for PIKQ-UI-10 were 0.718 and 0.710 for PIKQ-POP-10. Both scales showed excellent reliability (ICC>0.93). The PIKQ-UI-10 and PIKQ-POP-10 had SEM values of 0.24 and 0.31 and SDC of 0.66 and 0.85, respectively.

CONCLUSIONS

The PIKQ-Br with 10 questions and two-factor presented adequate measurement properties, and can be a useful instrument to assess women's knowledge about UI and POP.

Psychological and educational interventions for preventing falls in older people living in the community

BACKGROUND

Older adults are at increased risk of both falls and fall-related injuries. Falls have multiple causes and many interventions exist to try and prevent them, including educational and psychological interventions. Educational interventions aim to increase older people's understanding of what they can do to prevent falls and psychological interventions can aim to improve confidence/motivation to engage in activities that may prevent falls. This review is an update of previous evidence to focus on educational and psychological interventions for falls prevention in community-dwelling older people.

OBJECTIVES

To assess the benefits and harms of psychological interventions (such as cognitive behavioural therapy; with or without an education component) and educational interventions for preventing falls in older people living in the community.

SEARCH METHODS

We searched CENTRAL, MEDLINE, Embase, four other databases, and two trials registries to June 2023. We also screened reference lists and conducted forward-citation searching.

SELECTION CRITERIA

We included randomised controlled trials of community-dwelling people aged 60 years and older exploring the effectiveness of psychological interventions (such as cognitive behavioural therapy) or educational interventions (or both) aiming to prevent falls.

DATA COLLECTION AND ANALYSIS

We used standard methodological procedures expected by Cochrane. Our primary outcome was rate of falls. We also explored: number of people falling; people with fall-related fractures; people with falls that required medical attention; people with fall-related hospital admission; fall-related psychological outcomes (i.e. concerns about falling); health-related quality of life; and adverse events.

MAIN RESULTS

We included 37 studies (six on cognitive behavioural interventions; three on motivational interviewing; three on other psychological interventions; nine on multifactorial (personalised) education; 12 on multiple topic education; two on single topic education; one with unclear education type; and one psychological plus educational intervention). Studies randomised 17,478 participants (71% women; mean age 73 years). Most studies were at high or unclear risk of bias for one or more domains. Cognitive behavioural interventions Cognitive behavioural interventions make little to no difference to the number of fallers (risk ratio (RR) 0.92, 95% confidence interval (CI) 0.82 to 1.02; 4 studies, 1286 participants; low-certainty evidence), and there was a slight reduction in concerns about falling (standardised mean difference (SMD) -0.30, 95% CI -0.42 to -0.19; 3 studies, 1132 participants; low-certainty evidence). The evidence is very uncertain or missing about the effect of cognitive behavioural interventions on other outcomes. Motivational interviewing The evidence is very uncertain about the effect of motivational interviewing on rate of falls, number of fallers, and fall-related psychological outcomes. No evidence is available on the effects of motivational interviewing on people experiencing fall-related fractures, falls requiring medical attention, fall-related hospital admission, or adverse events. Other psychological interventions The evidence is very uncertain about the effect of health coaching on rate of falls, number of fallers, people sustaining a fall-related fracture, or fall-related hospital admission; the effect of other psychological interventions on these outcomes was not measured. The evidence is very uncertain about the effect of health coaching, guided imagery, and mental practice on fall-related psychological outcomes. The effect of other psychological interventions on falls needing medical attention or adverse events was not measured. Multifactorial education Multifactorial (personalised) education makes little to no difference to the rate of falls (rate ratio 0.95, 95% CI 0.77 to 1.17; 2 studies, 777 participants; low-certainty evidence). The effect of multifactorial education on people experiencing fall-related fractures was very imprecise (RR 0.66, 95% CI 0.29 to 1.48; 2 studies, 510 participants; low-certainty evidence), and the evidence is very uncertain about its effect on the number of fallers. There was no evidence for other outcomes. Multiple component education Multiple component education may improve fall-related psychological outcomes (MD -2.94, 95% CI -4.41 to -1.48; 1 study, 459 participants; low-certainty evidence). However, the evidence is very uncertain about its effect on all other outcomes. Single topic education The evidence is very uncertain about the effect of single-topic education on rate of falls, number of fallers, and people experiencing fall-related fractures. There was no evidence for other outcomes. Psychological plus educational interventions Motivational interviewing/coaching combined with multifactorial (personalised) education likely reduces the rate of falls (although the size of this effect is not clear; rate ratio 0.65, 95% CI 0.43 to 0.99; 1 study, 430 participants; moderate-certainty evidence), but makes little to no difference to the number of fallers (RR 0.93, 95% CI 0.76 to 1.13; 1 study, 430 participants; high-certainty evidence). It probably makes little to no difference to falls-related psychological outcomes (MD -0.70, 95% CI -1.81 to 0.41; 1 study, 353 participants; moderate-certainty evidence). There were no adverse events detected (1 study, 430 participants; moderate-certainty evidence). There was no evidence for psychological plus educational intervention on other outcomes.

AUTHORS' CONCLUSIONS

The evidence suggests that a combined psychological and educational intervention likely reduces the rate of falls (but not fallers), without affecting adverse events. Overall, the evidence for individual psychological interventions or delivering education alone is of low or very-low certainty; future research may change our confidence and understanding of the effects. Cognitive behavioural interventions may improve concerns about falling slightly, but this may not help reduce the number of people who fall. Certain types of education (i.e. multiple component education) may also help reduce concerns about falling, but not necessarily reduce the number of falls. Future research should adhere to reporting standards for describing the interventions used and explore how these interventions may work, to better understand what could best work for whom in what situation. There is a particular dearth of evidence for low- to middle-income countries.

A protocol for the co-creation and usability/acceptability testing of an evidence-based, patient-centred intervention for self-management of urinary incontinence in older men

Male urinary incontinence (UI) is most prevalent in older men, with one in three men aged 65 and above having problems maintaining continence. Addressing health inequalities, male-female disparities in continence services, and low health-seeking among men emphasizes the necessity for co-creating an intervention that empowers them to self-manage their UI. We aim to co-create a self-management intervention with an older men and Health care provider (HCP) group and assess its usability and/or acceptability among older men with UI. The intervention mapping (IM) framework, a co-creation strategy, will be used to co-create a self-management tool, followed by usability and/or acceptability testing. The study will be guided by the first four IM steps: the logic model of the problem, the logic model of change, program/intervention design, and program/intervention production, followed by preliminary testing. A participatory group of older men with UI recruited from an existing group of patient partners, and continence care experts will be involved in all steps of the IM process. Usability and/or acceptability testing will be conducted on a sample of 20 users recruited through seniors' associations and retirement living facilities. After accessing the self-management tool for a week, participants will complete a product usability testing scale (aka System Usability Scale-SUS) and/or an acceptability test, depending on the preferred mode(s) of intervention delivery. Data will be analyzed using descriptive statistics. A benchmark overall mean usability score of 70 represents a good/usable product, based on the large database of SUS scores.

A scoping review of risk factors for urinary incontinence in older men

BACKGROUND

Most epidemiological studies have not systematically identified or categorized risk factors for urinary incontinence (UI) in older men, despite a higher prevalence than in younger men. Considering the burden of UI, an understanding of risk factors can inform cost-effective prevention/treatment programs. This scoping review aimed to identify and categorise risk factors for UI in older men, identify gaps in the evidence, and opportunities for future research.

METHODS

The Joanna Briggs Institute (JBI) method for scoping reviews guided the conduct and reporting of this review alongside the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for scoping reviews checklist. JBI's Population, Concept, and Context approach framed the inclusion criteria (all evidence sources on UI risk factors that included older men [65 +]). We employed JBI's three-step search strategy, which included a limited initial search in Ovid MEDLINE, a detailed comprehensive database search, and a search of reference lists of included studies, Google Scholar and grey literature. There were no restrictions on language, study type, or publication date. Two independent reviewers screened, selected, and extracted eligible studies. Data were analyzed using descriptive statistics and qualitative content analysis.

RESULTS

Forty-seven articles that met the inclusion criteria identified 98 risk factors across six categories. Behavioural risk factors, reported by only two studies, were the least investigated of all the categories, whereas medical factors/diseases were the most investigated. No genetic factors were documented. The top five risk factors were increasing age/advanced age (n = 12), Benign Prostatic Hyperplasia (n = 11), Diabetes Mellitus (n = 11), Detrusor overactivity (n = 10), limitation in physical function/ADL disability (n = 10), increased Body Mass Index (BMI)/overweight/obesity (n = 8), Dementia (n = 8), and Parkinson's disease (n = 7).

CONCLUSION

There is a dearth of evidence to describe the role behavioural risk factors have in UI in older men. These factors may play a role in health promotion and disease prevention in this area.

REGISTRATION

A protocol detailing the methods was developed and published, and is registered in the Open Science Framework [Feb 07 2023; https://osf.io/xsrge/ ].

Urinary incontinence in older men: protocol for a scoping review of risk factors

INTRODUCTION

Urinary incontinence (UI) is common among older men. Epidemiological studies have established many risk factors for UI but these studies are not always specific to men aged 65 and above. The literature is yet to be systematically and comprehensively reviewed to identify UI risk factors specific to these men. Such evidence is required for the development of evidence-based interventions. This scoping review will synthesise evidence regarding UI risk factors in older men.

METHODS AND ANALYSIS

The Joanna Briggs Institute (JBI) method for scoping reviews will guide the conduct of this scoping review and its reporting alongside the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for scoping reviews checklist. JBI's Population, Concept and Context framework is used to frame inclusion criteria, and JBI's scoping review protocol template was used to format this protocol. Our comprehensive search will include Ovid MEDLINE, Ovid Embase, CINAHL, Scopus, Web of Science Core Collection, Cochrane Library (via Wiley) and ProQuest Dissertations & Theses Global. There will be no language restriction since approximately 10% of preliminary search results were in languages other than English. Study type or publication date will not be restricted. Besides databases, we will review Google Scholar results and bibliographies. Two independent reviewers will screen, select and extract eligible studies. A preliminary search was performed on 24 May 2022. The search strategy and data extraction template are in online supplemental appendix. A qualitative and quantitative analysis of data will be performed as a means of describing the risk factors for UI identified among older men by using frequencies and descriptive methods.

ETHICS AND DISSEMINATION

The review does not require ethics approval. Findings will be disseminated at conferences, in a peer-reviewed journal and used to inform the development of an evidence-based tool for self-management of UI in older men.

Promoting continence in older people

The prevalence of urinary incontinence (UI) is strongly associated with increasing age. Twenty five percent of women over 80 years of age have clinically significant symptoms in population surveys, but prevalence is as high as 70% in older hospital in-patients and residents of care homes with nursing. UI substantially affects quality of life and well-being, and generates significant economic burden for health and social care. Sadly, UI is considered as taboo by society, leading to isolation, depression and reluctance to seek help. As with all aspects of care of older people, a multi-modal approach to assessment and management is needed. Key to effective management of incontinence is recognition. As a minimum, clinicians should actively ask patients about continence, especially in older adults living with frailty. Careful evaluation and establishment of any underpinning diagnosis and aetiological factors requires comprehensive, multimodal, usually multidisciplinary, assessment. A lack of awareness of the problem and what can be done about it exists in both laypeople and clinicians, this needs correcting. An interdisciplinary approach to research and management must be the way into the future.

Perceptions and help-seeking behaviours among community-dwelling older people with urinary incontinence: A systematic integrative review

AIM

To synthesize research evidence on perceptions and help-seeking behaviours in community-dwelling older people with urinary incontinence based on the Capability-Opportunity-Motivation-Behaviours model.

BACKGROUND

Urinary incontinence is highly prevalent in community-dwelling older people, yet only a small proportion seek help from health professionals. Untreated urinary incontinence has a detrimental impact on older people's quality of life and distresses their caregivers.

DESIGN

Systematic integrative review.

DATA SOURCES

Ten databases were searched systematically between 9 November 2020 and 17 December 2020 including Medline (PubMed), CINAHL, Ageline, Web of Science, Scopus, ProQuest, Psyclnfo, CNKI, Wanfang and Vip.

REVIEW METHODS

Quality appraisal was applied to assess the quality of selected articles. Data relevant to the review aim were extracted from included articles for analysis. Convergent qualitative synthesis was used to synthesize findings.

RESULTS

Twenty articles were included and two main themes with six sub-themes were identified. Theme one described three common perceptions including urinary incontinence as a part of normal ageing, a stigma and a health problem. Each perception had a profound impact on older people's motivation to self-report the problem to health professionals. Theme two revealed three main help-seeking approaches comprising self-help, help from friends and help from health professionals. Of these, self-help was the dominant approach used to conceal urinary incontinence and contributed to social isolation.

CONCLUSION

Improving urinary incontinence management in community-dwelling older people requires the development of their capability and motivation, and increased opportunities to access and gain help from skilled health professionals.

IMPACT

Findings can facilitate resource development to improve health literacy for the general public pertinent to urinary incontinence and associated stigma. Moreover, findings can inform a user-friendly reporting and referral system for the problem. In addition, findings can inform education and skill training for health professionals, older people and their caregivers to effectively manage the problem.

Predicting response to a community-based educational workshop on incontinence among community-dwelling older women: Post hoc analysis of the CACTUS-D trial

AIMS

Our goal was to identify which women participating in an educational workshop on incontinence were most likely to benefit from it.

METHODS

We included women aged 65 or older, living in the community, and not treated for incontinence despite reporting urinary leakage at least twice a week. The workshop's aims were to change beliefs about accepting incontinence as a normal part of ageing, explain that incontinence is not irreversible, and that solutions exist. We performed structured interviews at 6 and 12 months to assess impressions of improvement (PGI-I) and changes in both continence (ICIQ-FLUTS) and quality of life (I-QOL).

RESULTS

The analysis included 392 women, 39% aged 80 or older and 57% with daily urinary incontinence. Twelve months after the workshop, 16% of women were "much better" (PGI-I); factors associated with impression of improvement were refusal to believe that incontinence is part of normal ageing at baseline and improvement of urinary symptoms. The median improvement was 4 points on the ICIQ-FLUTS and 8 on the I-QOL. Factors associated with a clinically significant improvement in urinary symptoms were more severe baseline urinary incontinence, obesity, and starting Kegel exercises. Factors associated with a clinically significant improvement in quality of life were a poor urinary quality of life at baseline and an age younger than 81 years.

CONCLUSIONS

A short, inexpensive and nonmedical intervention can change the mind-set and behavior of older women with incontinence who are not seeking care. A clinically significant improvement is possible even in women with severe symptoms.

Small-Group, Community-Member Intervention for Urinary and Bowel Incontinence: A Randomized Controlled Trial

OBJECTIVE

To evaluate the effects of Mind Over Matter: Healthy Bowels, Healthy Bladder, a small-group intervention, on urinary and bowel incontinence symptoms among older women with incontinence.

METHODS

In this individually randomized group treatment trial, women aged 50 years and older with urinary, bowel incontinence, or both, were randomly allocated at baseline to participate in Mind Over Matter: Healthy Bowels, Healthy Bladder immediately (treatment group) or after final data collection (waitlist control group). The primary outcome was urinary incontinence (UI) improvement on the Patient Global Impression of Improvement at 4 months. Validated instruments assessed incontinence, self-efficacy, depression, and barriers to care-seeking. Intent-to-treat analyses compared differences between groups. Target sample size, based on an anticipated improvement rate of 45% in treated women vs 11% in the control group, 90% power, type I error of 0.05, with anticipated attrition of 25%, was 110.

RESULTS

Among 121 women randomized (62 treatment group; 59 control group), 116 (95%) completed the 4-month assessment. Most participants were non-Hispanic white (97%), with a mean age of 75 years (SD 9.2, range 51-98); 66% had attended some college. There were no significant between-group differences at baseline. At 4 months, 71% of treated women vs 23% of women in the control group reported improved UI on Patient Global Impression of Improvement (P<.001); 39% vs 5% were much improved (P<.001). Regarding bowel incontinence, 55% of treated women vs 27% of women in the control group improved on Patient Global Impression of Improvement (P<.005), with 35% vs 11% reporting much improvement (P<.005). Treated women improved significantly more than women in the control group on all validated instruments of incontinence severity, quality of life, and self-efficacy. Care-seeking rates were similar between groups.

CONCLUSION

Participation in a small-group intervention improves symptoms of both urinary and bowel incontinence in older women. Mind Over Matter is a feasible model with potential to bring effective behavioral solutions to the community.

CLINICAL TRIAL REGISTRATION

ClinicalTrials.gov, NCT03140852.

Long-term effect of community-based continence promotion on urinary symptoms, falls and healthy active life expectancy among older women: cluster randomised trial

Background

The long-term effectiveness of group continence promotion delivered via community organisations on female urinary incontinence, falls and healthy life expectancy remains unknown.

Methods

A pragmatic cluster randomised trial was conducted among 909 women aged 65–98 years with urinary incontinence, recruited from 377 community organisations in the UK, Canada and France. A total of 184 organisations were randomised to an in-person 60-min incontinence self-management workshop (461 participants), and 193 to a control healthy ageing workshop (448 participants). The primary outcome was self-reported incontinence improvement at 1-year. Falls and gains in health utility were secondary outcomes.

Results

A total 751 women, mean age 78.0, age range 65–98 completed the trial (83%). At 1-year, 15% of the intervention group versus 6.9% of controls reported significant improvements in urinary symptoms, (difference 8.1%, 95% confidence intervals (CI) 4.0–12.1%, intracluster correlation 0.04, number-needed-to-treat 13) and 35% versus 19% reported any improvement (risk difference 16.0%, 95% CI 10.4–21.5, number-needed-to-treat 6). The proportion of fallers decreased from 42% to 36% in the intervention group (−8.0%, 95% CI −14.8 – −1.0) and from 44% to 34% in the control group (−10.3%, 95% CI −17.4 – −3.6), no difference between groups. Both intervention and control groups experienced a gain in health utility (0.022 points (95% CI 0.005–0.04) versus 0.035 (95% CI 0.017–0.052), respectively), with no significant difference between groups.

Conclusion

Community-based group continence promotion achieves long-term benefits on older women’s urinary symptoms, without improvement in falls or healthy life expectancy compared with participation in a healthy ageing workshop.

Is the belief that urinary incontinence is normal for ageing related to older Canadian women's experience of urinary incontinence?

INTRODUCTION AND HYPOTHESIS

Many women consider urinary incontinence (UI) a normal part of ageing. This belief may contribute to delays in treatment seeking. This study examined the relationship among holding that belief, UI type and severity, impact on quality of life, management and healthcare seeking in a sample of older community-dwelling Canadian women.

METHODS

This was a secondary analysis of a controlled trial examining the impact of continence promotion workshops on UI self-management. All women who consented and provided baseline data were included in this analysis regardless of eligibility for the main study.

RESULTS

The sample included 4446 women (2022 with UI) of mean (SD) age 78.2 (9.0) years and BMI 26.6 (5.6). The belief that UI is normal for ageing was held by 2149 women [48.3% (83.7% of 1798 incontinent women)] and was not associated with age [adjusted odds ratio (OR) (95% CI): 1.00 (0.99, 1.01), p = 0.72] or perception of overall health. Women with this belief had more impaired QoL compared with the women who felt UI was not normal for ageing [mean (SD) 83.9 (19.4) vs. 87.4 (18.6) (p < 0.01)]. This belief remained unaffected by daily UI and pad use up to 2/day.

CONCLUSIONS

More than two-thirds of women thought UI normal for ageing. This belief was not associated with age or perception of overall health. More severe incontinence and greater quantities of pad use did not make women less likely to hold this belief.

Performance of a Bayesian Approach for Imputing Missing Data on the SF-12 Health-Related Quality-of-Life Measure

BACKGROUND

Missing data in health-related quality-of-life outcomes are an ongoing problem. The 12-item short form health survey (SF-12) scores are no exception. Data imputation is complicated, because missingness may be partially predicted by the missing data themselves.

OBJECTIVES

To compare the performance of a Bayesian method for imputing SF-12 data with previously described frequentist imputation methods.

METHODS

SF-12 data were extracted from a trial assessing continence promotion on health-related quality of life in older women (n = 1052); the data set was split into a model development cohort for creating predictive models and a validation cohort to validate these models. Algorithms were constructed using data from the model development cohort to compute SF-12-related scores (physical health composite scale, the mental health composite scale, and the six-dimensional health state short form utilities). The Bayesian models used missing at random and missing not at random algorithms to impute missing SF-12 answers as categorical data. Comparative models replaced missing data with 0, used the mean weight of the sample, and regressed parameters from sociodemographic predictors. Data randomly deleted from the validation cohort were imputed with each algorithm, and the mean absolute error was used to gauge goodness of fit.

RESULTS

Each cohort included 526 persons; mean age was 78.1 ± 7.8 years. In the model development cohort, 15.6% of the participants had missing data. For the physical health composite scale, the mental health composite scale, and the six-dimensional health state short form utilities, the Bayesian model with missing at random data significantly outperformed all five comparison models, including the Bayesian models with missing not at random data.

CONCLUSIONS

Bayesian imputation was superior to other previously described methods for computing missing SF-12 data.

A Novel Research Definition of Bladder Health in Women and Girls: Implications for Research and Public Health Promotion

BACKGROUND

Bladder health in women and girls is poorly understood, in part, due to absence of a definition for clinical or research purposes. This article describes the process used by a National Institutes of Health funded transdisciplinary research team (The Prevention of Lower Urinary Tract Symptoms [PLUS] Consortium) to develop a definition of bladder health.

METHODS

The PLUS Consortium identified currently accepted lower urinary tract symptoms (LUTS) and outlined elements of storage and emptying functions of the bladder. Consistent with the World Health Organization's definition of health, PLUS concluded that absence of LUTS was insufficient and emphasizes the bladder's ability to adapt to short-term physical, psychosocial, and environmental challenges for the final definition. Definitions for subjective experiences and objective measures of bladder dysfunction and health were drafted. An additional bioregulatory function to protect against infection, neoplasia, chemical, or biologic threats was proposed.

RESULTS

PLUS proposes that bladder health be defined as: "A complete state of physical, mental, and social well-being related to bladder function and not merely the absence of LUTS. Healthy bladder function permits daily activities, adapts to short-term physical or environmental stressors, and allows optimal well-being (e.g., travel, exercise, social, occupational, or other activities)." Definitions for each element of bladder function are reported with suggested subjective and objective measures.

CONCLUSIONS

PLUS used a comprehensive transdisciplinary process to develop a bladder health definition. This will inform instrument development for evaluation of bladder health promotion and prevention of LUTS in research and public health initiatives.

Mind over bladder: Women, aging, and bladder health

The purpose of this study was to explore the efficacy and acceptability of an innovative, electronically delivered self-management intervention for urinary incontinence (UI) that included daily mindfulness practice, completion of sequential bladder diaries, and bladder health education to improve UI in older women living independently in a retirement community. A mixed methods pilot study was conducted over ten weeks using a custom website or CD. Ten women were recruited and 8 completed the study; 5 of those (71%) experienced fewer daily UI episodes post intervention (p = 0.055). The women also reported a statistically significant decrease in the impact UI had on their everyday life (p = 0.04). Seventy-one percent (N = 5) reported subjective improvement in UI, and high acceptability scores also were achieved. The intervention was both effective in helping older women self-manage UI and acceptable to the population group. Further research is needed with a larger and diverse population of older women.