Enhancing Recruitment in Urinary Incontinence Care: Insights from the EvidenceNOW Managing Urinary Incontinence Initiative.

INTRODUCTION AND HYPOTHESIS: Urinary incontinence (UI) affects over half of adult women but is widely underdiagnosed and undertreated in primary care due to stigma, normalization, and limited routine screening. Identifying effective recruitment strategies is essential to improving UI care in these settings.

METHODS

We conducted semi-structured interviews and focus groups with grantee leaders and practice facilitators (n = 32), site visits and virtual interviews with providers and staff (n = 47) and collected quarterly quantitative recruitment and retention data from five grantees participating in a nationwide UI initiative. Qualitative data were analyzed thematically using the Consolidated Framework for Implementation Research. Quantitative data, including 1950 enrolled practices and 134,852 screened patients, were summarized with descriptive statistics.

RESULTS

No single recruitment strategy was universally effective. All grantees utilized approaches such as leveraging professional relationships, engaging practice facilitators, and conducting in-person meetings, which were consistently linked to higher practice and provider recruitment. Leadership engagement facilitated recruitment success, while use of incentives and broad outreach alone were insufficient. Patient recruitment was most successful when UI screening was embedded in routine intake workflows. Across all grantees, 21% of screened patients tested positive for UI. Recruitment challenges included approval delays in large systems and increased workload related to integrating screening into routine care.

CONCLUSIONS

Successful UI intervention recruitment in primary care requires combining leadership support, workflow integration, and tailored approaches. Limitations include reliance on aggregate data and absence of patient-reported perspectives or subgroup analyses. Future research should further investigate strategies to advance equitable UI care delivery.