Improving Treatment for Urinary Incontinence Among Patients with Obesity and Type 2 Diabetes Mellitus through a Patient-Centered Collaborative Care Model

About This Grant

ABSTRACT- Urinary incontinence (UI) is a common condition that affects up to 60% of women in their lifetime and is more prevalent among patients with obesity and Type 2 diabetes mellitus (T2DM). UI, obesity, and T2DM share a bidirectional relationship where UI limits exercise essential for managing obesity and T2DM, while both conditions exacerbate UI severity. Evidence-based UI treatments include lifestyle changes and medications that can be offered in any clinical setting, yet only 15% of individuals with UI seek treatment due to shame and barriers to care. Healthcare burden (e.g., multiple appointments, varying clinicians) further complicates care. These challenges emphasize opportunities to combine care for these diagnoses and improve care access and treatment outcomes for all three conditions. Collaborative Care Models (CoCM) have demonstrated efficacy for treating chronic conditions in primary care settings while minimizing treatment burden. Prior research has highlighted successes and challenges of offering UI treatment in primary care settings, but there are research gaps in assessing implementation of UI care among women with obesity and T2DM. Patient preferences have not been systematically evaluated and applied to implementation solutions, and CoCMs have not been studied for UI specifically. Therefore, among women with obesity and T2DM with UI, our Specific Aims are to: (1) assess patient preferences for obtaining UI care in primary care settings using mixed methods with survey assessment (n=100) that will inform guides for interviews (n≈12-20) and integration of data; (2) design a patient-centered CoCM for UI with involvement of stakeholders using participatory design and the Integrated Promoting Action on Research Implementation in Health Services (iPARIHS) Framework; and (3) evaluate the feasibility, acceptability, and preliminary effectiveness of this CoCM for managing UI through pilot implementation for 6 months with n=30 patients in a primary care clinic treating women with obesity and T2DM. This research will be conducted at a large Federally Qualified Health Center (FQHC), where I serve as the only urogynecologist providing care to a population that mirrors US demographics. As a committed physician with training and experience in community-based research, I am uniquely suited to carry out this project. This intervention has potential to transform care by addressing three prevalent conditions through an integrated approach that may improve outcomes for all three conditions while reducing treatment burden. This K23 award will support my development as an independent investigator through training in: (1) mixed-methods research; (2) design of interventions using dissemination and implementation science principles; and (3) clinical trials. Through coursework, research experiences, and mentorship from experts in mixed methods, implementation science, biostatistics and clinical trials, I will be poised to become an independent investigator who is a leader in the design and implementation of novel strategies to address pelvic floor disorders and improve the health of women with obesity and T2DM.