Patient perceptions of an exercise training and healthy eating group program (ATHENA) for overweight and obese women with urinary incontinence: a qualitative descriptive study

Introduction: Urinary incontinence (UI) has profound effects on quality of life, physical and psychological wellbeing, and socioeconomic aspects of a woman’s life. It also places huge economic burden on health care systems; in Australia, UI treatment costs were estimated at AU$1.27 billion in 2018. Considering the ageing population and high prevalence of overweight and obesity, both risk factors for UI, health services must anticipate future increased demand on medical waitlists for patients with UI. Innovative, evidence-based service delivery options need to be developed and evaluated to address this. Group-based interventions may be an effective and efficient method of providing education and treatment to UI patients and could reduce overall costs. Our multidisciplinary team of experienced clinicians, researchers and a consumer representative has developed a novel, multifaceted group-based lifestyle intervention (an exercise training and healthy eating group program; ATHENA). ATHENA focuses on exercise training and dietary modification for overweight and obese women with UI, which is likely to be an effective and efficient way to deliver care that is in line with UI evidence-based practice guidelines. However, this groupbased intervention must be acceptable to patients in order to have an impact. Objective: This study aimed to explore patients’ perceptions of, and experiences with ATHENA, with a specific focus on acceptability. Methods: This nested qualitative, descriptive study was part of a larger feasibility study of ATHENA, which was implemented within an existing Women’s Health Physiotherapy (WHP) service at a large, tertiary, public hospital in Australia. Participants included a subset of patients from the larger ATHENA study (conducted over a 12-month period in 2019) who were purposively sampled to provide variation in presenting age, weight and clinical condition. Interviews were conducted over the telephone and in person using a semistructured interview guide consisting of questions within four domains: 1) Overall experience with; 2) Remembering and understanding; 3) Using and participating in; and 4) Perceived value of, ATHENA. Interviews were recorded, transcribed verbatim and analyzed thematically using Braun and Clarke’s six-step guide within a qualitative data analysis computer software package (NVivo). Results: A total of 11 women participated in interviews (mean age 54.3 years, mean BMI 32.7kg/m2 ). Overall, participants expressed positive responses to ATHENA, with initial analysis identifying several themes emerging from the data. These related to: 1) the group setting, which was considered a core aspect to ATHENA as the peer support gave participants confidence and motivation; 2) personal experiences with and attitudes towards UI, and how these changed over the course of ATHENA; and 3) perceived outcomes from participating in ATHENA. As data analysis is ongoing, finalized themes (including sub-themes) will be presented in detail at the conference. Conclusions: From initial analysis, participants expressed high acceptance of ATHENA, particularly in regard to the group-based delivery of the program. As a result, this novel group intervention has been incorporated into the existing WHP service. Ongoing analysis will provide further insight into participants’ satisfaction and experiences with ATHENA, which will inform sustainability within our health service, and possibly wider dissemination of ATHENA to other health services in the future.