(Poster 06) Barriers for Older Women with Overactive Bladder Using an Online Care Tool

Objectives: The objective of this study was to explore barriers to and facilitators of using an online portal-based tool, RAINBOW (Ready for Advances in Bladder health of Women) among older women presenting to care for treatment of Overactive Bladder (OAB). The goal was to enhance the usability, acceptability and feasibility of implementation of the tool in clinical practice.

Methods: We designed RAINBOW with multi-stakeholder engagement. We assembled a multi-disciplinary team of medical social scientists and four fellowship-trained urogynecologist to design the RAINBOW interface and content. The RAINBOW tool was designed to be used in our institution’s electronic patient portal. RAINBOW has four components: 1) systematic assessment of baseline comorbid conditions, medication use, and lower urinary tract symptoms; 2) monitoring of OAB symptoms, treatment response and adverse effects and facilitation of scheduling for clinician follow up as needed; and 3) prompting clinicians to transition patients to next line therapies as appropriate. Once developed, we conducted an exploratory mixed-methods study of RAINBOW. English-speaking women over the age of 65 who presented for treatment of OAB at a large academic health center were invited to interact with the tool and complete the assessments embedded within it. We then performed individual in-depth interviews. Quantitative data was analyzed descriptively. Thematic analysis drew from the Framework Method.

Results: Between January and June 2024, 47 patients were approached and 20 agreed to participate in the study. The mean age of the cohort was 75 ± 6 years. One fifth of participants (4/20) identified as Black while 15/20 (70%) identified as White. Most had advanced degrees 17/20 (85%). Half were married. Perceived barriers of RAINBOW included: (1) limitations of the tool’s ability to capture patient symptoms; and (2) unclear assessment language. Participants also expressed their own (3) limitations with medical terminology; and (4) struggles with technology. These barriers reportedly increased frustration with an already difficult to navigate health system. Perceived facilitators of RAINBOW included: (1) its simple readability and usability; and participants’ prior (2) familiarity with medical questionnaires; and (3) experience with MyChart. Participants who used technology regularly such as smartphones and iPads and those who were comfortable with completing assessments like the ones embedded in RAINBOW reported greater ease of use. All participants reported that the tool was easy to use and believed it could help their doctor improve the care they receive, especially when needing to schedule a follow-up appointment.

Conclusions: The RAINBOW Tool was acceptable to most older women with OAB who participated in this study. Limited understanding of medical terminology was the largest barrier to use of the tool, while readability and usability of the tool was the greatest facilitator. The results from this study are being used to enhance the tool or inform a larger implementation study.