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Digital Health Interventions Incorporating Behavior Change Techniques and Gamification for Bladder Health in Adults
Oscar Aguila-Gimeno1,2,3, Norina Gasteiger4, Emma Stanmore4
1Faculty of Health Sciences and Welfare, Research Group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Centre for Health and Social Care Research (CESS). University of Vic-Central University of Catalonia (UVic-UCC), Vic, Spain.
Background:
Urinary incontinence (UI) is the most prevalent pelvic floor dysfunction, with incidence increasing with age. Numerous studies have demonstrated the effectiveness of pelvic floor exercises in improving UI. However, access to pelvic floor treatment remains limited due to lengthy waiting lists and poor adherence to prescribed exercises. Digital solutions incorporating behavior change techniques (BCTs), including gamification elements, may support self-management of bladder health for individuals aged 50 years and older who may face challenges in accessing conventional treatments.
Objective:
This study aimed to identify mobile apps and websites integrating BCTs, including gamification elements, to facilitate bladder health self-management among adults aged 50 years and older.
Methods:
The search was initiated in July 2024 and updated in January 2025 across three sources: (1) mobile app stores (Google Play Store and Apple App Store available in Spain, Lithuania, and the United Kingdom) using the keywords "pelvic floor," "urinary incontinence," and "bladder"; (2) websites; and (3) academic databases (PubMed, Scopus, CINAHL, and Google Scholar) for journal articles, book chapters, and conference papers published in English, Spanish, or Lithuanian. Inclusion criteria required that solutions be independently usable without health care supervision, incorporate at least one BCT (eg, training, education), be evidence-informed (ie, include participants aged ≥50 years in their design or piloting phase or explicitly target this demographic), and be available in Spain, the United Kingdom, or Lithuania. The Mobile App Rating Scale (MARS) was used to assess app quality, and the taxonomy of 93 BCTs was used for BCT classification. All review and data extraction processes were conducted in duplicate.
Results:
Twenty-one studies met the inclusion criteria, identifying 8 eligible mobile apps and 1 website. Among the apps, only 2 were available on either Google Play or the Apple App Store. No apps were identified in Lithuania, whereas 1 app was found in Spain and 3 apps in the United Kingdom. Of these, 1 UK app was accessible on both Google Play and the Apple App Store, whereas the others were limited to a single platform. BCT extraction showed that the apps included between 9 and 16 BCTs (mean 12, SD 3.27). Regarding quality, all assessed apps obtained MARS scores ranging from 3 to 4 out of 5. Website searches did not identify any scientifically validated platforms across the 3 countries, except for 1 website cited in a scientific publication. UI reduction on the International Consultation on Incontinence Questionnaire ranged from -3.9 to -2.1 points, while perceived improvement reached 91.7% in the Tät app.
Conclusions:
Evidence-based digital interventions for individuals aged 50 years and older remain limited. Existing apps suggest potential benefits in UI reduction and quality of life improvement; however, further research and development are needed to enhance accessibility and efficacy.
