The URApp Carol Joinson designed for young people with continence problems was featured as a case study at the University's Festival of Enterprise. Benefits of URApp include the strong potential for improved engagement with urotherapy and therefore improved health, mental / emotional wellbeing and quality of life for young people, and reduced costs for the NHS.
Bladder and bowel problems are very common and can be affected by psychological issues and stressful life events in a child’s life. There is also strong evidence that bladder and bowel problems affect the mental health of children, young people and their parents. URApp is designed to support bladder training by providing reminders to drink at regular intervals throughout the day and to empty the bladder regularly.
The majority of cases of urinary incontinence (UI) in young people are not due to organic (structural, anatomical or neurological) causes but arise from functional impairments in the bladder. Bladder training (standard urotherapy) is the first-line treatment for UI in children and adolescents. It is a behaviour modification intervention that aims to establish a regular schedule of drinking and toilet visits. The goal is to ‘train’ the bladder to hold more urine and to reduce the number of times patients need to pass urine per day.
Professor Carol Joinson led a major research project funded by the Medical Research Council, to examine the risk factors and outcomes associated with continence problems in children and young people. The project used data from the Avon Longitudinal Study of Parents and Children (ALSPAC), but also generated new in-depth qualitative data describing the experiences of young people with continence problems. A major finding from this research was that many young people with continence problems do not feel adequately supported by current services and would really like to see improvements in the care they receive. In response to this need, the project team developed a smartphone app (URApp) to aid adherence to bladder training in young people with UI. This was co-designed with extensive input from young people and a team including expert clinicians, health psychologists, health technology design experts, and app developers. Co-designing URApp with young people helped to ensure it is age appropriate, acceptable and usable.
As well as URApp now being available as a free downloadable app and being actively recommended by paediatric continence clinics as a cost-effective, self-management solution for accessible, personalised and effective behaviour change support for young people experiencing UI, the MRC project and its reports also showed that many young people with continence problems are not receiving adequate support in secondary schools to allow them to manage their UI problems effectively. School governing bodies have a statutory duty under the Children and Families Act 2014 to ensure schools make arrangements to support pupils with medical conditions. The MRC project findings, key policy implications and recommendations for schools were captured in a Policy Briefing that highlighted to policymakers, including the Department for Education that specific guidance needed to be added to their statutory guidance on ‘Supporting Pupils with Medical Conditions at School’. In support of this, Carol secured further translational funding from the ESRC Impact Acceleration Account (IAA) to collaborate with ERIC, The Children’s Bowel and Bladder Charity, with young people themselves and secondary school staff: together they produced and promoted information resources for secondary schools. This included a film to teach secondary school staff about the unique needs of young people with continence problems and provide guidance on how to offer support.
"Benefits of URApp include the strong potential for improved engagement with urotherapy and therefore improved health, mental / emotional wellbeing and quality of life for young people, and reduced costs for the NHS".
Dr Anne Wright, Consultant Paediatrician, Children’s Bladder Clinic, Guy’s and St Thomas’ NHS Trust