Moving towards an 'animiction diary'? Animated instruction improves understanding of how to complete a bladder diary

Schlatmann F1, van Balken M1

Research Type

Clinical

Abstract Category

E-Health

Abstract 19
Products and Devices
Scientific Podium Short Oral Session 4
Wednesday 27th September 2023
11:45 - 11:52
Room 104CD
Questionnaire Voiding Diary Incontinence
1. Dep. Urology, Rijnstate Hospital, Arnhem, the Netherlands
Presenter
Links

Abstract

Hypothesis / aims of study
A frequently used questionnaire within urology is the bladder diary. Patients are asked for information on the amount, timing and frequency of micturition and fluid intake. The degree of urge and of urine leakage is also recorded, as is the time of rising and sleeping. The data is entered into a table for 24 hours. Properly completed, it provides valuable, objective information that can be obtained inexpensively. The use of the bladder diary is included in several international guidelines. However, the usefulness of the bladder diary depends heavily on complete and accurate data. However, completing the questionnaire is not easy: often a bladder diary is returned empty or incorrectly filled in. 
For the first time, we performed a qualitative study to investigate whether an animated fill-in instruction increases understanding of what is expected, compared to the regular textual fill-in instruction. Using the qualitative study design, we investigated the problems patients encounter and their causes.
Study design, materials and methods
Adults who had never completed a bladder diary before separately studied 1 of 2 versions of bladder diaries: the regular bladder diary with textual fill-in instruction (TBD), or the regular bladder diary without textual explanation but with the fill-in instruction in the form of an animation (ABD). People were asked to indicate in their own words how to fill in the bladder diary using the think-aloud method. In this method, a patient tells aloud what they think while filling in the questionnaire, which gives the researcher insight into the method of filling in such as order of answering the questions, which parts are not well understood (based on text or layout) or the reason why questions remain incomplete. This was followed by a standardized interview.
Predefined items were scored. A distinction was made between spontaneous responses and responses after undirected encouragement (such as, for example, "What would you do if I wasn't here?"). Targeted questions were then asked about possible improvements to the bladder diary, the text used in the filling-in instruction (TBD group), or possible improvements to the animation (ABD group). Education level and mother tongue were noted. Interviews continued, paying attention to equal distribution of education level, until no new insights were obtained.
Results
The TBD group consisted of 17 participants [med 63 years, 2 non-native speakers] and the ABD group consisted of 16 participants [med 59 years, 3 non-native speakers]. The bladder diary proved difficult for people of all education levels to understand because of the terminology used. In particular, the terms "urge", "involuntary" and "millilitre" were difficult to understand. The layout also made understanding difficult: completing a questionnaire in the form of a table is troublesome for some participants. The required understanding of numbers also made completing the questionnaire difficult.
4 TBD participants submitted the bladder diary blank (3 of them with low education level, 1 with high education level). The animated fill-in instruction combined clear language with comprehensible visuals, which improved comprehension of the bladder diary for all educational levels (see table). Participants in the ABD group filled in amount, timing and frequency of micturition and fluid intake more adequately than participants in the TBD group, with particularly better results seen among participants with low education levels. Participants in the ABD group also more adequately filled in their incontinence and urge symptoms and whether exchange bandages took place.
Of the 33 participants, 7 missed the opportunity to disclose information about urination, such as pain. The interview also showed that all non-native-speaking participants appreciated clarification of the text with visuals: understanding of how to complete the questionnaire improved and there was less uncertainty among these participants to complete the questionnaire.
Interpretation of results
In this qualitative study, the bladder diary with a textual fill-in instruction proved difficult to understand regardless of education level, leading to incomplete and inadequately completed questionnaires. An animated fill-in instruction improved comprehension for participants of all education levels, leading to more complete questionnaires with more valid data. For non-native-speaking participants, the animated fill-in instruction was easier to understand.
An animated fill-in instruction for the bladder diary, possibly complemented by a visual enhancement of the list itself, could lead to better completion quality and more reliable information.
Concluding message
Bladder diaries with textual fill-in instructions are difficult to understand for participants of all educational levels due to the terminology and layout used, this qualitative study showed. An animated fill-in instruction increases understanding of what is expected, compared to the regular textual fill-in instruction. Prospective research on the daily practice of the animated bladder diary fill-in instruction is being set up.
Figure 1 Table Results
Disclosures
Funding NONE Clinical Trial Yes Registration Number Local Feasibility Committee Rijnstate Hospital, Registration Number 2022-2110 RCT No Subjects Human Ethics Committee Local Feasibility Committee Rijnstate Hospital, Registration Number 2022-2110 Helsinki Yes Informed Consent Yes
Citation

Continence 7S1 (2023) 100737
DOI: 10.1016/j.cont.2023.100737

15/10/2024 10:37:58