The RISE FOR HEALTH study (RISE) was an initiative of the Prevention of Lower Urinary Tract Symptoms (PLUS) Research Consortium to improve bladder health in women and girls. The RISE study examined the risk and protective factors for bladder health and lower urinary tract symptoms (LUTS) in a cohort of well-characterized women, and assessed the distributions of bladder health and bladder health knowledge, attitudes, and beliefs in women from across the nation. Importantly, RISE explored the influence of novel factors, such as the toileting environment, behaviors, and positions, on bladder health, using new measures developed by the PLUS Research Consortium. The study benefited from transdisciplinary contributions from community engagement and cross-cultural experts to ensure that RISE was responsive to the needs of community members and used measures that were reviewed for acceptability and comprehension in diverse women, including Spanish language speakers. Together, these features helped RISE to the foundation for knowledge about antecedent risk and protective factors for bladder health and LUTS, and inform future studies designed to promote bladder health and prevent LUTS in women.

The primary objective was to identify risk and protective factors for bladder health and LUTS in women of all ages across the life course.

The secondary objective was to estimate the distributions of bladder health and bladder health knowledge, attitudes, and beliefs in women of all ages across the life course.

Participation involved completion of two baseline surveys; the first including information on bladder health and bladder health knowledge, attitudes, and beliefs (approximately 30 minutes). The second baseline survey (also approximately 30 minutes) included information on additional candidate risk and protective factors. Both surveys were intentionally designed to be brief and separated in order to reduce participant burden. A subset of participants were invited to attend an in-person evaluation at baseline to collect clinical risk and protective factor information. This information was used primarily to evaluate prospective associations between candidate clinical and biologic risk and protective factors with changes in bladder health and risk of LUTS over time.

The optional follow-up via mobile app called “WhereIGo” was designed to be a mobile application to collect environmental factors that affected toileting decisions and behaviors. This mobile app was designed and validated by the PLUS Consortium. The use of a mobile application advanced the scientific objectives of this study and the goals of PLUS by providing real-time data related to different environments and conditions that affected women’s toileting decisions and behaviors. “WhereIGo” used in-the-moment recording, sometimes called ecological momentary assessment, for a woman to report her experiences of “deciding where, when, and why to pee.” This provided insight into the associations between individual behaviors, environmental factors, and ways in which women manage their bladders in day-to-day life. The value of the app was its ability to capture real-time experiences compared to using recall when completing surveys, and the resulting data can be considered in assessing risk and protective factors for bladder health.

RISE FOR HEALTH Inclusion Criteria:

• Community dwelling in U.S. (non-institutionalized)
• Age ≥ 18 years
• Identify or born as female
• Able to read and understand English or Spanish and provide informed consent

WhereIGo Follow-Up Inclusion Criteria:

• Have participated in the first baseline survey
• Fluent in written and spoken English
• Owns a smartphone (Android or iOS), able to make phone calls, has previously downloaded at least one app through the app store
• Willing to respond to the mobile app prompts/texts and input data about toileting behaviors for a consecutive 72 hours
• Willing to leave home at least once during the 72 hour app usage period
• Stand/walk independently without human assistance (cane permitted)
• Will not change time zone during the use of the app
• Willing to add locations for work/school sites, must include their home location
• Has access to email to send study materials

Mother-Daughter Dyad Inclusion Criteria for Mother:

• Have participated in the first baseline survey
• Fluent in written and spoken English
• Living with or providing care for a daughter between the ages of 11-17 years

Mother-Daughter Dyad Inclusion Criteria for Daughter:

• Have female listed on their birth certificate
• Between 11-17 years old
• Fluent in written and spoken English
• Available for questionnaire completion during a video-assisted session
• Able to toilet voluntarily and without assistance

• Physical or mental health conditions that would prohibit self-administration of questionnaires either electronically or using paper and pencil (e.g., dementia/cognitive impairment/blindness/severe arthritis)
• Residence in a nursing home or other institutionalized living facility

A wide range of bladder well-being and function, and high utilization of adaptive/coping behaviors was found. Bladder health variability and utilization of adaptive/coping behaviors was also observed in women without urinary symptoms, highlighting bladder health dimensions not captured by traditional urinary symptom tools and potentially identifying a group of women with “sub-clinical” symptoms who may be at greater risk of developing urinary symptoms. LUTS, particularly storage LUTS such as urgency and incontinence, were common and bothersome in the general female study population, yet often untreated. Given this large burden, both prevention and treatment-related interventions are warranted to reduce the high prevalence and symptoms of LUTS.