Decision Preparedness and User Experience with a Urinary Incontinence Patient Decision Aid in U.S. Primary Care

Patient decision aid (PDA) use for urinary incontinence (UI) in primary care settings is understudied. We evaluated users' experiences with a specialty-developed UI PDA implemented in primary care. We also examined the association of decision preparedness, perceived usability, and time spent in the PDA with user experience and summarized user feedback.

This concurrent mixed-methods secondary analysis included women aged ≥18 years with bothersome UI in primary care who accessed a computerized PDA. User experience was assessed using likelihood-to-recommend (LTR) ratings as a global user-experience measure, with ratings of 9-10 categorized as promoter status. Decision preparedness and perceived usability were assessed using validated questionnaire items reflecting decisional conflict and usability domains. Free-text feedback was summarized qualitatively to elaborate opportunities to improve user experience.

Of the 958 users who completed the PDA, 240 (25.1%) provided LTR ratings; the mean LTR was 6.0 (SD 3.5), and 31% were promoters. In multivariable logistic regression adjusting for decision preparedness, perceived usability, and time spent in the PDA, both decision preparedness (aOR 4.92; 95% CI 2.68-9.25) and perceived usability (aOR 1.75; 95% CI 1.22-2.60) were associated with promoter status. Time spent in PDA was not associated with promoter status. Qualitative findings complemented quantitative results by highlighting opportunities to improve clarity, accessibility, and personalization.

Fewer than one-third of the respondents gave the highest likelihood-to-recommend ratings. Decision preparedness and perceived usability were associated with favorable user experience, suggesting that primary care implementation of UI PDAs may require greater attention to decisional readiness, personalization, and integration with clinician discussion.