Culturally Adapted Digital Behavioral Therapy for Overactive Bladder in Black Women: An Innovative AI-Assisted Approach

About This Grant

ABSTRACT Overactive bladder (OAB) is a prevalent and costly health condition that poses a significant public health burden in the United States. It is well established that OAB disproportionately affects women. Recent studies have also highlighted differences in bladder health outcomes specifically in Black women. Despite Black women being more likely than their White counterparts to experience Urgency Urinary incontinence, Black women are also 54% less likely to receive OAB medications known to be safer and more tolerable and are 17-34% less likely to receive advanced therapies. OAB behavioral therapy (BT) is a highly efficacious, low-risk treatment option that can significantly improve overall quality of life and is recommended by The American Urological Association as a first line therapy for OAB. However, studies have shown that multi-level barriers, including social determinants of health and bladder stigma, often hinder utilization of BT in Black female OAB patients. Remotely delivered relevant and technology-supported preventive health interventions offer a viable technique for increasing OAB symptom awareness and self-management practices among Black women. The CeCe App is a novel, conversational agent-based application for delivering validated, patient-centered education and coaching targeted to women with symptoms of OAB. CeCe allows its users to learn about their condition and manage their symptoms. A usable and accessible, evidence-based application like CeCe can be used to help U.S. Black women overcome the barriers to OAB care that they face by educating them on how to improve OAB symptoms. Renalis proposes adapting OAB CeCe for Black women in the US aged 30 and older, while also modernizing the technology from a rule-based, decision-tree chatbot to an AI-informed conversational agent, thereby enhancing scalability, personalization, and user trust. Shifting CeCe’s architecture to an AI-informed natural language model will enable more adaptive, scalable, attuned, and relationship-centered conversations and coaching,a crucial feature for building trust among Black women, who have had limited representation in the development and testing of digital health chatbots. To accomplish this, Aim 1 will solicit feedback on the existing OAB CeCe intervention, the relevance of AI, and the need to use AI to improve bladder health with Black women. Aim 2 will expand the OAB CeCe chatbot with AI structure and content that is culturally informed for Black women. In Aim 3 we will conduct an early-stage usability and acceptability study of the adapted AI CeCe app. The research design creates space for dynamic cross-talk between the data and stakeholders to influence the next research step and materials (e.g., focus groups, survey items, analysis steps). This new version of the CeCe App will lead to increased accessibility & availability of OAB BT, improved patient adherence and improved OAB symptoms and quality of life among the Black female community.