To use an existing population health survey to (1) understand the reach of bladder health promotion when disseminated electronically; and (2) compare women who engage with bladder health promotion disseminated electronically versus via postal mail.

In partnership with the Survey of the Health of Wisconsin (SHOW), emails were sent to all adult women who participated in the 2017 SHOW survey, had valid email addresses, and agreed to be contacted regarding future studies. This email contained a link to a bladder health promotion website (www.obgyn.wisc.edu/bladder) where women could access an electronic brochure, watch a 20 minute video (1), and download a mobile application for stress incontinence (2). Two weeks later, SHOW participants received an email invitation to participate in a brief electronic survey about their engagement with the bladder health promotion website. Reminder emails were sent 2 and 4 weeks later to non-responders. Electronic survey responses were collected in REDCap and merged with demographic and other health-related data previously collected by SHOW. 

Descriptive analyses characterized respondents’ engagement with bladder health promotion materials and compared respondents from this electronic study with respondents from an analogous study, which used postal mail to disseminate bladder health promotion materials to adult women participating in 2016 SHOW. Results from this postal mail survey have been presented at ICS previously.

Among 437 adult women in 2017 SHOW, valid email addresses were available for 310 (71%), of whom 122 (39%) responded. This response rate was lower than the response rate of 54% (214/399) attained with the analogous mail survey to the 2016 SHOW sample.

Table 1 describes the sample of respondents and non-respondents in the 2017 email survey and the 2016 postal survey. For the 2017 email survey, we also provide descriptors for those without a valid email address (n=127; 110 without any email address, 17 with invalid email address). The 2016 and 2017 cohorts had similar distributions of age, BMI, education and race. The prevalence of urinary incontinence was similar (231/395, 58% in 2016; 243/427, 57% in 2017).

In both cohorts, responders were statistically significantly more likely than non-responders to be non-Hispanic white and have a household income above the 200% Federal Poverty Level (FPL). In the 2017 email cohort, women without a valid email address were older (p<0.001) and more likely to report income below the 200% FPL (p=0.04); they were also more likely to have severe urinary incontinence (p=0.035) and to identify as non-white (p=0.01) than women with a valid email address. 

Figure 1 presents engagement with bladder health promotion materials among survey respondents. When disseminated via mail, 73% engaged with the printed brochure. The email dissemination of materials led to higher levels of engagement with electronic materials including the website (53%), video (41%), and app downloads (10%) compared to lower overall engagement with the same electronic materials using postal mail dissemination.

Bladder health outreach via email reaches younger, more educated women, with more resources, who are more likely to be white. Bladder health outreach via email dissemination led to higher engagement with electronic resources, while the mail survey led to higher engagement overall.

Efforts to disseminate bladder health promotion via mail or email are likely to miss non-white women and those with fewer resources (education, poverty). Future work should partner with women from these groups through community engagement to tailor outreach to minimize disparities. Dissemination methods should align with format of materials. A suggested strategy that may improve the uptake of materials is dissemination via text messages.

Sampselle CM, Newman DK, Miller JM, et al. A Randomized Controlled Trial to Compare 2 Scalable Interventions for Lower Urinary Tract Symptom Prevention: Main Outcomes of the TULIP Study. J Urol. 2017;197(6):1480-1486.
Asklund I, Nystrom E, Sjostrom M, Umefjord G, Stenlund H, Samuelsson E. Mobile app for treatment of stress urinary incontinence: A randomized controlled trial. Neurourol Urodyn. 2017;36(5):1369-1376.