App-based treatment for female urinary incontinence: evidence-based eHealth as an alternative to care-as-usual

App-based treatment for female urinary incontinence. Urinary incontinence affects 1 in 3 women, and only few of them ask for help. Pelvic floor muscle training and bladdertraining are effective, however they are also costly and adherence varies. An app-based treatment could offer a solution. There are already over 100 incontinence-apps available, but research into their effectiveness is scarce. It is important to know if an app is as effective as care-as-usual, before women start downloading and using it. We developed an app-based treatment for stress-, urgency- and mixed type female urinary incontinence. We compared the app with care-as-usual in a randomized controlled trial and we performed interviews. This thesis shows that an app-based treatment is at least as effective as care-as-usual and cheaper. We personalized treatment-decision as we predicted per patient, based on her characteristics, which of both treatment options would lead to the most improvement of incontinence. Interviews with women with high- and low treatment effect showed that factors that act as facilitators and barriers are very personal. In general, adherence is the most important factor for success. Furthermore, factors that were expected to facilitate (for example graphs and reminders) for some women actually had an opposite effect. App-based treatment for urinary incontinence offers a viable alternative to care-as-usual. Based on these results, the URinControl-app is now freely available for all women in the Netherlands (urincontrol.online). This was subsidized by ZonMw and part of further research into implementation. Scientific results are translated into illustrations, they are available in the thesis and on the website www.urincontrol.nl