Implementation of an evidence-based app to improve healthcare for female urinary incontinence: identification of implementation strategies using the consolidated framework for implementation research-expert recommendations for implementation change matching tool.

BACKGROUND

Female urinary incontinence (UI) affects one in three women and is frequently managed suboptimally. The app-based treatment URinControl demonstrated cost-effectiveness. However, implementation in Dutch primary care is limited. This study aimed to identify key barriers to implementation and develop strategies to support the uptake of URinControl in primary care settings.

METHODS

We conducted a cross-sectional survey among Dutch general practitioners (GPs), community pharmacists, and supporting personnel working in general practice or local pharmacies. Barriers were identified using the Consolidated Framework for Implementation Research (CFIR). Potential implementation strategies were selected using the CFIR-Expert Recommendations for Implementing Change (ERIC) matching tool.

RESULTS

A total of 174 healthcare professionals completed the questionnaire. Key barriers from both GP and pharmacy perspectives included doubts about the relative advantage of the app, limited knowledge of urinary incontinence and the app, organizational constraints, and limited digital skills among patients. In pharmacies, additional barriers included limited opportunity to discuss UI and concerns about financing. Based on these findings, five implementation strategies were developed.

INTERPRETATION: Effective implementation of an evidence-based digital app for urinary incontinence in primary care requires improved awareness, knowledge, and support for healthcare professionals, as well as better structural integration of digital health tools into routine practice. Broader policy and societal shifts toward acceptance of eHealth are also needed. We also translated barriers into five tailored, theory-informed strategies addressing clinician education, patient engagement, workflow integration, financing, and collaboration between general practice and community pharmacy settings across the Netherlands in routine care implementation.