@Article{info:doi/10.2196/56533,
author="Smith, Abigail R
and Mueller, Elizabeth R
and Lewis, Cora E
and Markland, Alayne
and Smerdon, Caroline
and Smith, Ariana L
and Sutcliffe, Siobhan
and Wyman, Jean F
and Low, Lisa Kane
and Miller, Janis M",
title="Assessment of Environmental, Sociocultural, and Physiological Influences on Women's Toileting Decisions and Behaviors Using ``Where I Go'': Pilot Study of a Mobile App",
journal="JMIR Mhealth Uhealth",
year="2025",
month="Feb",
day="12",
volume="13",
pages="e56533",
keywords="ecological momentary assessment; time location factors; voiding diary; voiding behaviors; population studies; mobile application; app; bladder health; data collection tool; decision support",
abstract="Background: Little is known about women's decisions around toileting for urination and how those decisions influence moment-to-moment behaviors to manage bladder needs. The new smartphone app ``Where I Go'' captures such nuanced and granular data in real-world environments. Objective: This study aims to describe participant engagement with ``Where I Go'', variation in novel parameters collected, and readiness for the data collection tool's use in population-based studies. Methods: ``Where I Go'' has three components: (1) real-time data, (2) short look-back periods (3‐4 h), and (3) event location (GPS recorded at each interaction). The sample size was 44 women. Recording of real-time toileting events and responding to look-back questions was measured over 2 days of data collection. The participant's self-entered location descriptions and the automatic GPS recordings were compared. Results: A total of 44 women with an average age of 44 (range 21-85) years interacted with the app. Real-time reporting of at least 1 toileting event per day was high (38/44, 86{\%}, on day 1 and 40/44, 91{\%}, on day 2) with a median of 5 (IQR 3-7 on day 1 and IQR 3-8 on day 2) toileting events recorded each day. Toileting most commonly occurred at home (85/140, 61{\%}, on day 1 and 129/171, 75{\%}, on day 2) due to a need to go (114/140, 66{\%}, on day 1 and 153/171, 74{\%}, on day 2). The most common reasons for delaying toileting were ``work duties'' (33/140, 21{\%}, on day 1 and 21/171, 11{\%}, on day 2) and ``errands or traveling'' (19/140, 12{\%}, on day 1 and 19/171, 10{\%}, on day 2). Response to at least 1 look-back notification was similarly high (41/44, 93{\%}, on day 1 and 42/44, 95{\%}, on day 2), with number of responses higher on average on day 2 compared with day 1 (mean on day 1=3.2, 95{\%} CI 3.0-3.5; mean on day 2=4.3, 95{\%} CI 3.9-4.7; P<.001). Median additional toileting events reported on the look-back survey were 1 (IQR 1-2) and 2 (IQR 1-2) on days 1 and 2, respectively. Overall concordance between self-reported location recording and GPS was 76{\%} (188/247). Participants reported lower urge ratings when at home versus away when reporting real-time toileting (median rating 61, IQR 41-84 vs 72, IQR 56-98), and daily fluid intake showed a small to medium positive correlation with toileting frequency (day 1 r=0.3, day 2 r=0.24). Toileting frequency reported in ``Where I Go'' showed a small positive correlation with the frequency item from the International Consultation on Incontinence Questionnaire (r=0.31 with day 1 toileting frequency and r=0.21 with day 2 toileting frequency). Conclusions: ``Where I Go'' has potential to increase the understanding of factors that affect women's toileting decisions and long-term bladder health. We anticipate its use as a data collection tool in population-based studies. International Registered Report Identifier (IRRID): RR2-10.2196/54046 ",
issn="2291-5222",
doi="10.2196/56533",
url="https://mhealth.jmir.org/2025/1/e56533",
url="https://doi.org/10.2196/56533"
}