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Effectiveness Of A Digital Health Intervention For Pediatric Lower Urinary Tract Symptoms: Preliminary Data
Chenxi Liu, PhD, Jacky Chu, BS,
Kathleen M. Kan, MD.
Stanford University School of Medicine, Stanford, CA, USA.
Background Urotherapy (UT) involves health education on bladder health and is an effective treatment for pediatric lower urinary tract symptoms (LUTS). However, families do not have access to high-quality bladder health education outside of a clinic, limiting access. The overall aim of this project was to pilot Bladder Basics (BB), a novel, self-paced digital health intervention that delivers bladder health education at home and prior to medical visits. We examined early data regarding BB’s effectiveness in improving bladder symptoms in children, bladder health knowledge among parents, and instructional design and acceptability. Methods Our longitudinal pretest-posttest study design included children ages 5-10 years who screened positive for LUTS based on the Dysfunctional Voiding Symptom Score (DVSS) and their parents. Participants watched BB over a four-week period (7 videos, each ~5-10 minutes) and completed outcome measures at baseline, 4 weeks, and 3 months post-intervention. Bladder symptoms were measured using DVSS, bladder health knowledge in parents using a knowledge survey, and instructional components using the Attention, Relevance, Confidence, and Satisfaction Model and Technology Acceptance Model. Changes over time were analyzed using paired t-test and McNemar’s test. Results 39 children and their parents completed BB. Children were mostly female (74%), White/European (55%), and exclusively English-speaking (80%). Parents were well-educated (41% with master’s degrees), employed full-time (56%), and had a household income of >$100k (74%).
DVSS scores improved significantly at 4 weeks and 3 months, with score reductions of 27% and 53%, respectively. 43% and 67% of children who initially screened positive for LUTS improved to score below the cutoff after 4 weeks and 3 months. The percentage of participants planning to have a 1:1 clinic visit remained constant at 26% from baseline to 4 weeks. Baseline bladder health knowledge was high and improved by 1 question. Correct answers to the question "How often should your child pee?" improved from 76.90% to 97.40%. Parents responded that BB captured their attention (80%), instilled confidence (89%), and was relevant (92%) and satisfying (77%). Children saw BB as enjoyable, easy to understand, important, and fun. 72% to 100 % of parents recognized BB as highly acceptable.
Conclusions Preliminary data from this pilot study demonstrates improvements in bladder symptoms and bladder health knowledge. Engagement and acceptability metrics suggest the potential for widespread adoption. The next steps include continued recruitment and refinement of the program based on participant feedback.
Table 1. Paired t-test and McNemar’s Test Results for DVSS and Knowledge Scores
| | | | | | | | |
| Timepoint | T-test | | McNemar’s Test |
| n | Mean (SD) | t (df) | p | | n (%) Positive | % Difference (95% CI) | p |
| Children’s DVSS Scores |
| Baseline | 35 | 12.1 (3.34) | -3.41 (34) | 0.002 | | 35 (100%)a | -42.86% [-59.25% ~ -26.46%] | 0.001 |
| 4 weeks | 35 | 8.83 (4.75) | - | - | | 20 (57%)a | - | - |
| Baseline | 18 | 11.8 (3.54) | -5.1 (17) | <0.001 | | 18 (100%)a | -66.67% [-88.44% ~ -44.89%] | 0.005 |
| | | | | | | | |
| | | | | | | | |
| 3 months | 18 | 5.56 (3.90) | - | - | | 6 (33%)a | - | - |
| Parents’ Knowledge Scores |
| Baseline | 39 | 9.79 (1.22) | -4.826 (38) | <0.001 | | 30 (77%)b | 20.51% [7.84% ~ 33.19%] | 0.008 |
| Post-BB | 39 | 10.67 (0.53) | - | - | | 38 (97%)b | - | - |
| Baseline | 18 | 9.83 (1.10) | -4.075 (17) | <0.001 | | 16 (89%)b | 5.56% [-5.03% ~ 16.14%] | 1 |
| 3 months | 18 | 10.56 (0.70) | - | - | | 17 (94%)b | - | - |
a Children who were positive for LUTS.
b Parents who correctly answered the question “How often should your child pee?”
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