Fecal incontinence (FI) (referred to in this study as accidental bowel leakage [ABL]) is considered a chronic condition as there currently is no cure with the exception of surgical correction of some physical abnormalities. It is important that patients must engage in ongoing self-management of FI which is optimized by support from a plan of care developed with their healthcare provider. Mobile health applications (apps) have been shown to promote self-management support of chronic health conditions [1]. We had developed an initial, first-of-its-kind HIPAA-compliant mobile app named I’M ABLe (for I can Manage Accidental Bowel Leakage) to provide self-management support for individuals with FI, which had a very good System Usability Score (70 (13.0)). The purpose of this analysis was to describe general use and ease and confidence of use of the I’M ABLe app by patients with FI.

A descriptive analysis of data collected during a randomized controlled pilot study of the app was conducted.

     In the parent study, 20 patients with FI recruited from a university-affiliated urogynecology clinic were randomly assigned in a 1:1 ratio to the app group (AppGroup) or the usual care control group. All participants were female. Both groups had a FI self-management plan developed with their healthcare provider. Only the AppGroup used the I’M ABLe app for 5 weeks to support their FI self-management. The data of the 10 participants in the AppGroup were analyzed. 

     The I’M ABLe app had 3 sections: 1) Home – contained a user guide, 23 short, educational “articles” about FI and self-management whose topics were included after input with focus groups of patients with FI and available to all users, and a list and instructions for 13 initial conservative interventions for FI. Each intervention had an associated diary or journal (hence referred to as journals) for recording self-management activities. Interventions and journals specific to a participant’s FI self-management plan developed with their healthcare provider were activated at enrollment, so that participants had access only to information appropriate for them. 2) Me – listed the FI interventions and journals to be completed daily with links. 3) Settings – showed graphs or tables illustrating trends in progress on key outcomes reported on a journal and offered a place to record goals, barriers and facilitators for FI self-management. A participant’s healthcare provider could review information entered in real time. 

     App use was assessed by analyzing the app’s logs that recorded and stored data about participants’ app access. Using questionnaires, the AppGroup self-reported their characteristics at the start of the study and ratings of ease of and confidence in using the app at the end of the 5-week study. Data were summarized using descriptive statistics.

Characteristics of the AppGroup (n (%)) completing the Background survey (9/10, (90%)) were: Age (years): 30-39, n=1 (11.1%), 50-59, n=1 (11.1%), 60+, n=7 (77.8%); Gender: Female, n=9 (100%); Race: Black, African American, or African, n=3 (33.3%), White, n=6 (66.7%); Ease of learning new technology such as a mobile app: Don’t learn easily but would like to become better, n=3 (33.3%), Learn easily, n=3 (33.3%), Learn very easily, n=3 (33.3%); Number of health-related apps previously used: 1 app, n=1 (11.1%),1-2 apps, n=4 (44.4%), 3-5 apps, n=4 (44.4%); Type of technology adopter: Early, n=1 (11.1%), Late, n=1 (11.1%), Between early and late adopter, n=7 (77.8%). 

     See Table 1 for a description of general app use by the AppGroup. 

     Optional educational articles: The percentage of the AppGroup (n=10) that accessed the various optional educational articles available to all app users was as follows: What is a normal bowel movement and stool=50%, What is ABL=40%, Risk factors for ABL= 40%, Achieving a regular bowel elimination pattern= 30%, Normal process of emptying the bowel without leakage=30%, Relaxation to help you cope emotionally with ABL=10%, Recommended position and tips for bowel elimination= 30%, Bowel clean-up and skin care= 20%, Fluid intake=30%, You are not the only one with ABL=30%, Medication side effects=20%, Practical tips for locating public toilets=20%, Relaxation: Mindfulness and breathing=10%, Activating self-management=10%, Benefit of developing a self-management plan with a clinician=10%, Practical tips, cleansing kits=10%, Relaxation: Meditation=10%, Relaxation: Yoga=10%, and Taking care of yourself =10%.

     Table 2 reports the AppGroup’s ease and confidence in using the app at the end of the study.

Experience using apps and ease of learning new technologies varied among participants; most described themselves as between early and later adopters of new technology. The number of participants accessing the app and counts of its use shows the app seemed to engage patients with FI. Most participants accessed the app user guide and instructions about performing interventions in the app after receiving explanations in the clinic. Access of optional educational articles varied by topic, and those providing information explaining normal bowel elimination, FI, and risks for FI were among the more popular. The majority of app users found the app easy to use and were confident in using it.

Findings show that adult women with FI of varying ages, levels of experience using health related mobile apps, and perceived ability to learn new technology were interested in and able to use the I’M ABLe app with good confidence and ease. Results identify topics of interest for patient education.

[1] Whitehead L, Seaton P The Effectiveness of Self-Management Mobile Phone and Tablet Apps in Long-term Condition Management: A Systematic Review J Med Internet Res 2016;18(5):e97