Measuring Bladder Health: Development and Cognitive Evaluation of Items for a Novel Bladder Health Instrument

Leslie M. Rickey, Melissa L. Constantine, Emily S. Lukacz, Jerry L. Lowder, Diane K. Newman, Linda Brubaker, Kyle Rudser, Cora E. Lewis, Lisa K. Low, Mary H. Palmer, Todd Rockwood

Research output: Contribution to journalArticlepeer-review

4 Scopus citations


Purpose:We describe the item development and cognitive evaluation process used in creating the Prevention of Lower Urinary Tract Symptoms Bladder Health Instrument (PLUS-BHI).Materials and Methods:Questions assessing bladder health were developed using reviews of published items, expert opinion, and focus groups' transcript review. Candidate items were tested through cognitive interviews with community-dwelling women and an online panel survey. Items were assessed for comprehension, language, and response categories and modified iteratively to create the PLUS-BHI.Results:Existing measures of bladder function (storage, emptying, sensation components) and bladder health impact required modification of time frame and response categories to capture a full range of bladder health. Of the women 167 (18-80 years old) completed individual interviews and 791 women (18-88 years) completed the online panel survey. The term "bladder health" was unfamiliar for most and was conceptualized primarily as absence of severe urinary symptoms, infection, or cancer. Coping mechanisms and self-management strategies were central to bladder health perceptions. The inclusion of prompts and response categories that captured infrequent symptoms increased endorsement of symptoms across bladder function components.Conclusions:Bladder health measurement is challenged by a lack of awareness of normal function, use of self-management strategies to mitigate impact on activities, and a common tendency to overlook infrequent lower urinary tract symptoms. The PLUS-BHI is designed to characterize the full spectrum of bladder health in women and will be validated for research use.

Original languageEnglish
Pages (from-to)1407-1414
Number of pages8
JournalJournal of Urology
Issue number5
StatePublished - May 1 2021


  • health status indicators
  • health surveys
  • interviews as topic
  • lower urinary tract symptoms
  • urinary bladder


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