Lisa Kane Low

Fetal heart rate surveillance is a standard component of intrapartum care. The fetal heart rate can be evaluated using intermittent auscultation or electronic fetal monitoring. Research that has compared these 2 strategies found them to be equivalent with respect to long‐term neonatal outcomes. The purpose of this clinical bulletin by the American College of Nurse‐Midwives is to review evidence for the use of intermittent auscultation and provide recommendations for intermittent auscultation technique, interpretation, and documentation.

Background: Women commonly experience lower urinary tract symptoms (LUTS), such as frequent urination, urgent urination, and urinary incontinence. Health education for women rarely focuses on LUTS prevention and promotion of bladder health. The Theory of Reasoned Action and the Theory of Planned Behavior have been used to explain and change a variety of health behaviors. Missing from the literature is an explicit test of whether constructs of these theories are associated with LUTS and bladder health, and whether toileting habits explain this association. Objectives: To inform prevention strategies, this investigation tested whether the Theory of Reasoned Action and Theory of Planned Behavior constructs (attitudes toward, perceived norms of, and perceived control over specific toileting behaviors) are associated with women’s toileting habits, and whether these habits mediate associations of theoretical constructs and women’s LUTS and bladder health. Methods: The Prevention of Lower Urinary Tract Symptoms Research Consortium developed theoretical constructs to match four toileting behavior domains (delayed voiding, straining, crouching/hovering over toilets when away from home, and avoiding public toilets) assessed by the validated Toileting Behaviors: Women’s Elimination Behaviors scale. Using a population-based survey, data were then collected from women at nine sites in the United States. Cross-sectional regression analyses tested whether toileting habits in a given domain mediated associations of corresponding theoretical constructs with reported LUTS, bladder health, and bladder function. Results: The overall analytic sample included 1,472 women with a mean age of 48 years. Associations of norms favoring delayed voiding and low perceived control over timing of voiding with more frequent LUTS and poorer bladder health and function were partially mediated by delayed voiding habits. Favorable attitudes toward and norms of straining (i.e., pushing down to urinate) and avoiding public toilets were associated with more frequent LUTS through corresponding toileting habits. Discussion: Longitudinal research is needed to confirm study findings. Future prevention intervention research may include nursing and public health messaging designed to shape attitudes toward and perceived norms of specific toileting behaviors, as well as policies to enhance control over healthy toileting practices in public spaces, including schools and workplaces.

Purpose: Research exists exploring prevalence of lower urinary tract symptoms (LUTS) in cisgender heterosexual women yet validated instruments have not been used to survey sexual and gender minority (SGM) people. Alongside LUTS measures, recently validated bladder health instruments were used in the RISE FOR HEALTH Study that included expanded demographic information of sexual orientation, gender identity, and sex assigned at birth questions. Materials and Methods: The RISE FOR HEALTH study is a population-based prospective cohort survey study of adults born female, recruited from a commercial marketing database. Participants who responded to questions identifying them as SGM people were compared with age-matched non-SGM participants. Chi-square and t tests were used for comparison between groups in general, and in the age-matched sample paired t tests, McNemar, and McNemar-Bowker tests were used. Results: Among 98% of participants who answered sexual and gender identity questions (3364 of 3424), 260 (8%) met sexual and gender subset criteria with a selected group of 260 non-SGM people participants for the age-matched comparison. The SGM participants had significantly lower bladder health scores and bladder function indices yet there were no significant differences in lower urinary symptoms between the SGM participants and the age matched non-SGM participants. Conclusions: In this study, SGM populations had bladder health and bladder function outcomes suggesting poorer bladder health and higher risk for LUTS compared with cisgender populations.

Background: Little is known about women’s decisions around toileting for urination and how those decisions influence moment-to-moment behaviors to manage bladder needs. The new smartphone app “Where I Go” captures such nuanced and granular data in real-world environments. Objective: This study aims to describe participant engagement with “Where I Go”, variation in novel parameters collected, and readiness for the data collection tool’s use in population-based studies. Methods: “Where I Go” has three components: (1) real-time data, (2) short look-back periods (3‐4 h), and (3) event location (GPS recorded at each interaction). The sample size was 44 women. Recording of real-time toileting events and responding to look-back questions was measured over 2 days of data collection. The participant’s self-entered location descriptions and the automatic GPS recordings were compared. Results: A total of 44 women with an average age of 44 (range 21-85) years interacted with the app. Real-time reporting of at least 1 toileting event per day was high (38/44, 86%, on day 1 and 40/44, 91%, on day 2) with a median of 5 (IQR 3-7 on day 1 and IQR 3-8 on day 2) toileting events recorded each day. Toileting most commonly occurred at home (85/140, 61%, on day 1 and 129/171, 75%, on day 2) due to a need to go (114/140, 66%, on day 1 and 153/171, 74%, on day 2). The most common reasons for delaying toileting were “work duties” (33/140, 21%, on day 1 and 21/171, 11%, on day 2) and “errands or traveling” (19/140, 12%, on day 1 and 19/171, 10%, on day 2). Response to at least 1 look-back notification was similarly high (41/44, 93%, on day 1 and 42/44, 95%, on day 2), with number of responses higher on average on day 2 compared with day 1 (mean on day 1=3.2, 95% CI 3.0-3.5; mean on day 2=4.3, 95% CI 3.9-4.7; P<.001). Median additional toileting events reported on the look-back survey were 1 (IQR 1-2) and 2 (IQR 1-2) on days 1 and 2, respectively. Overall concordance between self-reported location recording and GPS was 76% (188/247). Participants reported lower urge ratings when at home versus away when reporting real-time toileting (median rating 61, IQR 41-84 vs 72, IQR 56-98), and daily fluid intake showed a small to medium positive correlation with toileting frequency (day 1 r=0.3, day 2 r=0.24). Toileting frequency reported in “Where I Go” showed a small positive correlation with the frequency item from the International Consultation on Incontinence Questionnaire (r=0.31 with day 1 toileting frequency and r=0.21 with day 2 toileting frequency). Conclusions: “Where I Go” has potential to increase the understanding of factors that affect women’s toileting decisions and long-term bladder health. We anticipate its use as a data collection tool in population-based studies.

Background: Although surveys and apps are available for women to report urination and bladder symptoms, they do not include their decisions regarding toileting. Real-world factors can interfere with toileting decisions, which may then influence bladder health. This premise lacks data per want of a robust data collection tool. Objective: The Prevention of Lower Urinary Tract Symptoms (PLUS) research consortium engaged a transdisciplinary team to build and test WhereIGo, a mobile data collection app for Android and iOS. The design goal was a comprehensive reporting system for capturing environmental, sociocultural, and physical factors that influence women’s decisions for toileting. Aims include having (1) an innovative feature for reporting physiologic urge sensation when “thinking about my bladder” and shortly before “I just peed,” (2) real-time reporting along with short look-back opportunities, and (3) ease of use anywhere. Methods: The development team included a plain language specialist, a usability specialist, creative designers, programming experts, and PLUS scientific content experts. Both real-time and ecological momentary assessments were used to comprehensively capture influences on toileting decisions including perceived access to toileting, degree of busyness or stress or focus, beverage intake amount, urge degree, or a leakage event. The restriction on the maximal number of taps for any screen was six. PLUS consortium investigators did pilot-testing. Formal usability testing relied on the recruitment of community-dwelling women at four PLUS research sites. Women used the app for 2 consecutive days. Outcome measures were the system usability scale (SUS; 0-100 range) and the functional Mobile Application Rating Scale (1-5 range). These scales were embedded at the end of the app. The estimated a priori sample size needed, considering the SUS cut point score set at ≥74, was 40 women completing the study. Results: Funding was provided by the National Institute of Diabetes and Digestive and Kidney Diseases since July 2015. The integrity of the build process was documented through multiple 5-minute videos presented to PLUS Consortium and through WhereIGo screenshots of the final product. Participants included 44 women, with 41 (93%) completing data collection. Participants ranged in age from 21 to 85 years, were predominantly non-Hispanic White (n=25, 57%), college-educated (n=25, 57%), and with incomes below US $75,000 (n=27, 62%). The SUS score was 78.0 (SE 1.7), which was higher than 75% of the 500 products tested by the SUS developers. The mean functional Mobile Application Rating Scale score was 4.4 (SE 0.08). The build and informal acceptability testing were completed in 2019, enrollment for formal usability testing completed by June 2020, and analysis was completed in 2022. Conclusions: WhereIGo is a novel app with good usability for women to report toileting decisions, urination, and fluid intake. Future research using the app could test the influence of real-time factors on bladder health. International Registered Report Identifier (IRRID): RR1-10.2196/54046

Community engagement has been named a research priority by the National Institutes of Health, and scholars are calling for community engagement as an approach to address racism and equity in science. Robust community-engaged research can improve research quality, increase inclusion of traditionally marginalized populations, broaden the impact of findings on real-life situations, and is particularly valuable for underexplored research topics. The goal of this paper is to describe lessons learned and best practices that emerged from community engagement in a multi-institution population health research consortium. We describe how a foundation was laid to enable community-engaged research activities in the consortium, using a staged and stepped process to build and embed multi-level community-engaged research approaches. We staged our development to facilitate (a) awareness of community engagement among consortium members, (b) the building of solidarity and alliances, and (c) the initiation of long-term engagement to allow for meaningful research translation. Our stepped process involved strategic planning; building momentum; institutionalizing engagement into the consortium infrastructure; and developing, implementing, and evaluating a plan. We moved from informal, one-time community interactions to systematic, formalized, capacity-building reciprocal engagement. We share our speed bumps and troubleshooting that inform our recommendations for other large research consortia—including investing the time it takes to build up community engagement capacity, acknowledging and drawing on strengths of the communities of interest, assuring a strong infrastructure of accountability for community engagement, and grounding the work in anti-racist principles.

Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author). Background: Although surveys and apps are available for women to report urination and bladder symptoms, they do not include their decisions regarding toileting. Real-world factors can interfere with toileting decisions, which may then influence bladder health. This premise lacks data per want of a robust data collection tool. Objective: The Prevention of Lower Urinary Tract Symptoms (PLUS) research consortium engaged a transdisciplinary team to build and test WhereIGo, a mobile data collection app for Android and iOS. The design goal was a comprehensive reporting system for capturing environmental, sociocultural, and physical factors that influence women’s decisions for toileting. Aims include having (1) an innovative feature for reporting physiologic urge sensation when “thinking about my bladder” and shortly before “I just peed,” (2) real-time reporting along with short look-back opportunities, and (3) ease of use anywhere. Methods: The development team included a plain language specialist, a usability specialist, creative designers, programming experts, and PLUS scientific content experts. Both real-time and ecological momentary assessments were used to comprehensively capture influences on toileting decisions including perceived access to toileting, degree of busyness or stress or focus, beverage intake amount, urge degree, or a leakage event. The restriction on the maximal number of taps for any screen was six. PLUS consortium investigators did pilot-testing. Formal usability testing relied on the recruitment of community-dwelling women at four PLUS research sites. Women used the app for 2 consecutive days. Outcome measures were the system usability scale (SUS; 0-100 range) and the functional Mobile Application Rating Scale (1-5 range). These scales were embedded at the end of the app. The estimated a priori sample size needed, considering the SUS cut point score set at ≥74, was 40 women completing the study. Results: Funding was provided by the National Institute of Diabetes and Digestive and Kidney Diseases since July 2015. The integrity of the build process was documented through multiple 5-minute videos presented to PLUS Consortium and through WhereIGo screenshots of the final product. Participants included 44 women, with 41 (93%) completing data collection. Participants ranged in age from 21 to 85 years, were predominantly non-Hispanic White (n=25, 57%), college-educated (n=25, 57%), and with incomes below US $75,000 (n=27, 62%). The SUS score was 78.0 (SE 1.7), which was higher than 75% of the 500 products tested by the SUS developers. The mean functional Mobile Application Rating Scale score was 4.4 (SE 0.08). The build and informal acceptability testing were completed in 2019, enrollment for formal usability testing completed by June 2020, and analysis was completed in 2022. Conclusions: WhereIGo is a novel app with good usability for women to report toileting decisions, urination, and fluid intake. Future research using the app could test the influence of real-time factors on bladder health.