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After the Randomized Trial: Implementation of Community-Based Continence Promotion in the Real World.

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Mind over Matter (MOM) workshops effectively addressed incontinence in older women. Community agencies successfully adopted and maintained the program, showing its real-world feasibility and the need for partner-centered support.

Keywords:
bowel incontinencecommunity-based health promotiondissemination and implementationfecal incontinenceurinary incontinence

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Area of Science:

  • Gerontology
  • Public Health
  • Behavioral Science

Background:

  • Urinary incontinence affects most women over 65, leading to significant healthcare costs and reduced quality of life.
  • Despite prevalence, older women often do not seek care for incontinence.
  • The Mind over Matter: Healthy Bowels, Healthy Bladder (MOM) program is a community-based self-management workshop proven to improve incontinence.

Purpose of the Study:

  • To evaluate the real-world adoption, maintenance, and implementation of the MOM program by community agencies.
  • To identify facilitators and barriers to the program's dissemination following a randomized controlled trial (RCT).

Main Methods:

  • Mixed methods approach combining quantitative tracking of adoption and maintenance rates with qualitative data from interviews and focus groups.
  • Assessment of implementation fidelity by trained observers during MOM sessions.
  • Study involved community agencies serving older adults in six Wisconsin communities.

Main Results:

  • 67% of communities adopted MOM, and 50% maintained the program beyond the initial implementation phase.
  • High implementation fidelity was observed, with no lapses in protocol adherence.
  • Key facilitators included MOM's organized protocol, low time commitment, inter-organizational collaboration, dedicated health promotion staff, and community interest. Barriers included stigma, funding, competing priorities, and participant/partner engagement challenges.

Conclusions:

  • Assessing implementation outcomes alongside clinical RCTs is feasible using dissemination and community engagement strategies.
  • Partner-centered implementation support packages can effectively address barriers to program adoption and maintenance in community settings.