Assessment of Environmental, Sociocultural, and Physiological Influences on Women’s Toileting Decisions and Behaviors Using “Where I Go”: Pilot Study of a Mobile App

TL;DR

A new mobile app called 'Where I Go' was tested to understand how and why women choose where and when to urinate, capturing real-time data and behaviors.

Contribution

The study introduces and validates a novel smartphone app for collecting detailed, real-world toileting data from women.

Findings

High engagement with the app was observed, with most participants reporting at least one toileting event per day.

Home was the most common toileting location, and work duties and errands were the main reasons for delaying urination.

Self-reported locations matched GPS data 76% of the time, showing the app's potential for accurate data collection.

Abstract

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.

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.

“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.

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).

“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.

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