Long-Term Effects of a Self-management Program for Older Women With Urinary Incontinence in Rural Korea A Comparison Cohort Study

PURPOSE: The purpose of the study was to examine the long-term effects of a urinary incontinence (UI) self-management program for older women on the severity, knowledge, and attitudes regarding UI. DESIGN: This was a quasi-experimental design (nonrandomized trial) with intervention and comparison groups. SUBJECTS AND SETTING: Participants were recruited from a primary health care facility in rural Korea. Forty-four older women with UI were assigned to either the intervention or the control group. Of 44 participants, 26 (17 experimental and 9 control) completed the study: 7 participants did not meet inclusion criteria (eligibility criteria partially relied on scores of a validated instrument measuring UI severity administered after initial consent to study participation), and 6 dropped out of the intervention group because of admission to hospital, hearing problems, difficulty traveling to meetings, and disinterest in the program. Five subjects in the comparison group were lost to follow-up. METHODS: The intervention group (n = 17) underwent a 5-session UI self-management educational program held once weekly. Its contents included a lecture, instruction on pelvic muscle exercises, and assignments related to action plans (exercises and a daily bladder diary). The study's main outcome measures were the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) score, along with knowledge and attitudes toward UI measured by the UI knowledge scale (UIKS) and UI attitude scale (UIAS). Data were collected at baseline, immediately following the intervention, and at the 1-year follow-up. Repeated-measures analysis of variance was used to analyze changes in ICIQ-SF, UIKS, and UIAS scores over time. RESULTS: A significant improvement in UI severity was found in the intervention group, who showed a gradually decreasing ICIQ-SF score from at pretest to 5 weeks and 12 months, while it increased over the 12-month period in the control group (main effect of group, F = 17.31, P < .001; main effect of time, F = 8.45, P = .001; interaction effect, F = 22.54, P < .001). There was no significant improvement in UIKS scores over time. Scores on the UIAS changed significantly over time in the experimental group (chi(2) = 6.76, P = .034), but the mean score at 1-year follow-up (mean +/- standard deviation: 2.61 +/- 0.56) was lower than the mean score at baseline (2.64 +/- 0.19). CONCLUSIONS: Study findings suggest that the UI self-management educational program is effective for improving UI and related lower urinary tract symptoms and feasible to conduct as a long-term intervention program for older women living in communities. However, strategies for a systematic follow-up management are needed for long-term retention of improved UI knowledge and attitudes toward incontinence.