# Optimizing Remote Access to Urinary Incontinence Treatment for Women Veterans

> **NIH VA I01** · BIRMINGHAM VA MEDICAL CENTER · 2022 · —

## Abstract

Background: Primary care and prevention research among women Veterans across the life cycle is an area of
increasing focus within VA Health Administration (VHA). Increasing numbers of women Veterans are using the
VA for their general and gender-specific health care, representing a doubling in the past decade with 7% of all
Veterans seen in the VHA being women. Up to 20 percent of women Veterans experience urinary incontinence
(UI) and may be at increased risk due to exposures during military service, such as restricted toilet access and
the impact of heavy protective gear and equipment on the pelvic floor. These factors, along with known risk
factors such as pregnancy, childbirth, and menopausal transitions increase UI risk among women Veterans.
Significance/Impact: This proposed clinical trial focuses on improving access to first-line treatments for
women Veterans with UI. Several evidence-based treatments are available for UI including behavioral,
medical, and surgical therapies. Behavioral self-management treatments including pelvic floor muscle training,
bladder control strategies, and fluid management are widely recommended by guidelines as first-line treatment
options because of their demonstrated effectiveness and low risk of side effects. Women who receive
behavioral therapy for UI report greater confidence in self-management when provided with input from a
clinician with specific training in UI management. To identify gaps in UI treatment modalities within VHA, we
surveyed VA gynecologists, urologists, and behavioral and physical therapy providers for first-line treatment
options at VA Medical Centers across the nation. We found that only 55% of facilities reported offering pelvic
floor muscle training (PFMT), while 14% referred to another VA, and 44% referred to non-VA care. Sixteen
percent of facilities did not provide PFMT. Our data demonstrated that women Veterans have limited access to
clinicians who can provide these safe and effective treatments.
Innovation: Given the identified need to improve access to UI treatments, we developed and tested two
remote delivery models: an interactive mobile-health or mHealth UI smart phone/computer application and a
clinical video telehealth (CVT) visit. This proposed study will incorporate an innovative sequential, multiple
assignment, randomized trial (SMART) design to determine the optimal method for remote delivery.
Specific Aims: Our specific aims are to: (1) compare the effectiveness among women Veterans of two remote
delivery models for evidenced-based behavioral UI treatment, an interactive mHealth smart phone/computer
application versus a remote CVT visit; (2) use a SMART design to optimize UI symptom improvement for
women who do not respond to either type of remote delivery; (3) explore key factors that could influence future
remote UI treatment dissemination. Our overarching hypothesis is that women Veterans who receive the
interactive mHealth application will achieve greater reduction...

## Key facts

- **NIH application ID:** 10101489
- **Project number:** 5I01HX002827-02
- **Recipient organization:** BIRMINGHAM VA MEDICAL CENTER
- **Principal Investigator:** Alayne Denise Markland
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2022
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2020-01-01 → 2023-12-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10101489

## Citation

> US National Institutes of Health, RePORTER application 10101489, Optimizing Remote Access to Urinary Incontinence Treatment for Women Veterans (5I01HX002827-02). Retrieved via AI Analytics 2026-05-21 from https://api.ai-analytics.org/grant/nih/10101489. Licensed CC0.

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