title: Client and clinical staff perceptions of barriers to and enablers of the uptake and delivery of behavioural interventions for urinary incontinence: qualitative evidence synthesis.
abstract: OBJECTIVE
  To evaluate factors influencing uptake and delivery of behavioural interventions for urinary incontinence from the perspective of clients and clinical staff.
  
  
  BACKGROUND
  Behavioural interventions are recommended as first-line therapy for the management of urinary incontinence. Barriers to and enablers of uptake and delivery of behavioural interventions have not been reviewed.
  
  
  METHODS
  Qualitative evidence synthesis.
  
  
  METHODS
  MEDLINE, EMBASE, CINAHL, PsychInfo, AMED (inception to May 2013); Proceedings of the International Continence Society (ICS) (2006-2013).
  
  
  METHODS
  Studies where data were collected from clients or staff about their experiences or perceptions of behavioural interventions were included. Two reviewers independently screened records on title and abstract. Full-text papers were obtained for records identified as potentially relevant by either reviewer. Two reviewers independently filtered all full-text papers for inclusion, extracted findings and critically appraised studies. We used an approach akin to Framework, using a matrix of pre-specified themes to classify the data and facilitate its presentation and synthesis.
  
  
  RESULTS
  Seven studies involving 200 participants identified clients' views. Findings identified from at least one study of moderate quality included increased fear of accidents and convenience of treatment. Factors enabling participation included realistic goals and gaining control. Six studies involving 427 participants identified staff views. Findings identified from at least one study of moderate quality included staff education and perceptions of treatment effectiveness. Enabling factors included teamwork and experience of success.
  
  
  CONCLUSIONS
  There is little detailed exploration of clients' experiences of, and responses to, behavioural interventions. Evidence for staff relates predominantly to prompted voiding in long-term residential care. Studies of the uptake and delivery of other behavioural interventions in other settings are warranted.
authors.affiliation: School of Health, University of Central Lancashire, Preston, UK.
authors.forename: Beverley
authors.initials: B
authors.lastname: French
authors.affiliation: School of Health, University of Central Lancashire, Preston, UK.
authors.forename: Lois H
authors.identifier: http://orcid.org/0000-0001-5218-6546
authors.initials: LH
authors.lastname: Thomas
authors.affiliation: School of Health, University of Central Lancashire, Preston, UK.
authors.forename: Joanna
authors.initials: J
authors.lastname: Harrison
authors.affiliation: School of Health, University of Central Lancashire, Preston, UK.
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Coupe
authors.affiliation: Evidence Based Practice Research Centre, Edge Hill University, Ormskirk, UK.
authors.forename: Brenda
authors.identifier: http://orcid.org/0000-0001-8227-0116
authors.initials: B
authors.lastname: Roe
authors.affiliation: Department of Nursing and Community Health, School of Health and Life Sciences, Glasgow Caledonian University, UK.
authors.forename: Joanne
authors.initials: J
authors.lastname: Booth
authors.affiliation: School of Health Sciences, University of East Anglia, Norwich, UK.
authors.forename: Francine M
authors.initials: FM
authors.lastname: Cheater
authors.affiliation: School of Health, University of Central Lancashire, Preston, UK.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Leathley
authors.affiliation: School of Health, University of Central Lancashire, Preston, UK.|Faculty of Health Sciences, Australian Catholic University, Sydney, New South Wales, Australia.
authors.forename: Caroline L
authors.identifier: http://orcid.org/0000-0002-9403-3772
authors.initials: CL
authors.lastname: Watkins
authors.affiliation: Rehabilitation Teaching and Research Unit, Department of Medicine, University of Otago, Wellington, New Zealand.|Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
authors.forename: Jean
authors.initials: J
authors.lastname: Hay-Smith
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001521:Behavior Therapy / Q000379:methods*; D003144:Communication Barriers; D003695:Delivery of Health Care / Q000379:methods*; D005069:Evaluation Studies as Topic; D005260:Female; D006282:Health Personnel / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D014549:Urinary Incontinence / Q000628:therapy*
keywords: behavioural interventions; bladder training; management of incontinence; nursing; pelvic floor muscle training; prompted voiding; qualitative evidence synthesis; systematic review; urinary incontinence