Effectiveness of an Online Health Education Program for Pediatric Lower Urinary Tract Symptoms.

Effectiveness of an Online Health Education Program for Pediatric Lower Urinary Tract Symptoms - PMC Skip to main content An official website of the United States government Here's how you know Here's how you know Search Log in Primary site navigation Search Log in Search PMC Full-Text Archive Search in PMC Journal List User Guide As a library, NLM provides access to scientific literature. Inclusion in an NLM database does not imply endorsement of, or agreement with, the contents by NLM or the National Institutes of Health. Learn more: PMC Disclaimer | PMC Copyright Notice Urology . Author manuscript; available in PMC: 2026 May 31. Published in final edited form as: Urology. 2025 May 31;204:171–178. doi: 10.1016/j.urology.2025.05.058 Effectiveness of an Online Health Education Program for Pediatric Lower Urinary Tract Symptoms Chenxi Liu a , Jacky Chu a , Kathleen M Kan a Author information Article notes Copyright and License information a Department of Urology, Stanford University School of Medicine, 453 Quarry Road, Palo Alto, CA 94304, USA ✉ Address correspondence to: Kathleen M. Kan, MD, Department of Urology, Stanford University School of Medicine, 750 Welch Road, Ste 218, Stanford, CA 94305, USA; kkan@stanford.edu Issue date 2025 Oct. PMC Copyright notice PMCID: PMC12282474  NIHMSID: NIHMS2091512  PMID: 40456454 The publisher's version of this article is available at Urology Abstract Objective Urotherapy effectively treats pediatric lower urinary tract symptoms, but its delivery is limited in clinical settings. We examined the feasibility and effectiveness of Bladder Basics, a home-based, self-paced online bladder health education program, in improving symptoms and knowledge. Methods Children aged 5 - 10 years with bladder symptoms and their parents were recruited. All participants completed Bladder Basics over four weeks, with outcomes measured at baseline, 4 weeks, and 12 weeks. Feasibility was evaluated through recruitment, engagement, and post-assessment completion. Secondary outcomes included dysfunctional voiding symptom scores, parents’ subjective improvement, care-seeking interest, bladder health knowledge, and self-efficacy. Analyses included paired t-tests, Wilcoxon tests, sign tests, and McNemar’s tests. Results Of 70 families, 72% completed the program, 73% completed the 4-week survey, and 67% completed the 12-week survey. Symptom scores improved significantly: 32% at 4 weeks and 42% at 12 weeks. Of children initially screening positive for bladder symptoms, 39% fell below the cutoff score at 4 weeks and 55% at 12 weeks. 85% and 93% of parents reported child symptom improvements at 4 and 12 weeks. Parents reporting no need for clinic visits increased from 45% to 69% at 4 weeks. Knowledge of key urotherapy concepts was improved, such as peeing every 3 hours and bowel health awareness. Self-efficacy improved significantly, with a median increase of 4.6 points at 4 weeks ( p = 0.018). Conclusions Bladder Basics improved bladder symptoms and knowledge and demonstrated potential for broader scalability with strong participant interest and high engagement. Clinical Trial Registration Number NCT05852353 Keywords: Pediatric, Bladder, lower urinary tract symptoms (LUTS), Urotherapy, Patient Education INTRODUCTION Pediatric lower urinary tract symptoms (LUTS) affect approximately 22% of school-age children, primarily those aged 5-10 years. 1 Functional LUTS includes daytime urinary incontinence (DUI), nocturnal enuresis, urge incontinence, urgency, frequency and dysuria. 2 LUTS is associated with increased risks of urinary tract infection (UTI) and parental stress, and decreased self-esteem and quality of life. Healthcare visits for LUTS have increased over time, 3 and LUTS diagnoses account for up to 37% of pediatric urology referrals. 4 Urotherapy (UT) is a first-line treatment recommended by the International Children’s Continence Society (ICCS) for DUI, non-monosymptomatic nocturnal enuresis and fecal incontinence. 5 Key education topics include “demystifying” the bladder’s role and function in the body and counseling on behavioral change and lifestyle modification. 5 UT has demonstrated a 7-fold increase in resolving DUI compared to watchful waiting 6 and is the primary driver of improvement. 7 Despite its effectiveness, the delivery of UT primarily in clinical settings limits public accessibility. While novel formats, like group UT and bladder training videos, have demonstrated non-inferiority to traditional UT, they remain underutilized. 8 , 9 Only 16% of children with LUTS seek care, regardless of severity. 10 Existing online bladder health education materials are often of poor quality and difficult to understand by national standards, limiting their usefulness for most families. 11 There is a need for an evidence-based, publicly available resource that delivers the education components of UT to 1) support clinical treatment efforts and 2) provide families with accessible health information before medical visits. Bladder Basics (BB) is a self-paced online program delivering bladder health education directly to families in the home setting. 12 The aim of this pilot study is to evaluate 1) the feasibility of recruiting participants to complete BB and 2) its preliminary effectiveness in improving LUTS and bladder health knowledge. We hypothesize that BB is feasible to implement in a home setting and will lead to improvements in both bladder symptoms and bladder health knowledge among participants. METHODS Study Design This study was approved by the Institutional Review Board (IRB No. 67807) and registered with ClinicalTrials.gov ( NCT05852353 ). All study participants received the intervention, and outcomes were measured using a longitudinal pretest-posttest design. Population Parents of children aged 5-10 years with LUTS were recruited from our pediatric urology clinic, local pediatric practices and the community. Community recruitment involved flyers posted in public libraries, community and childcare centers and community-based organizations. Interested parents completed a screening survey and the Dysfunctional Voiding Symptom Score (DVSS). 13 Eligible participants included English-speaking, potty-trained children aged 5-10 years residing in California with DVSS scores >6 for females and >9 for males, and their parents. Written informed consent was obtained over Zoom. Children who had received UT within the last 12 months, vesicoureteral reflux, severe hydronephrosis (Society of Fetal Urology Grade III/IV), neurogenic bladder, posterior urethral valves, continuous incontinence, monosymptomatic nocturnal enuresis and UTI were excluded. Participants with learning disabilities or chronic medical conditions were excluded using age-appropriate survey items from the National Survey of Children’s Health. 14 The exclusion criteria, based on prior literature, aimed to exclude non-functional LUTS cases unlikely to respond to UT and children who required additional support to engage with the learning materials. 2 , 15 Intervention BB consists of 7 animated videos, each 4-7 minutes long. The intended audience is children aged 5-10 years and their parents, as they are the largest group impacted by LUTS. 1 The curriculum was adapted from the ICCS-defined UT with pre-defined educational objectives ( Supplementary Table S1 ) after incorporating feedback from local pediatric urologists, pediatricians and community members. 5 Interactive games and songs align the content with the National Institutes of Health’s Clear & Simple standards for patient education 16 and the Centers for Disease Control and Prevention’s standards for a comprehensive school health program. 17 Videos were hosted on LearnDash, a learning management system via our university’s online learning platform ( Supplementary Figure S1 ). English subtitles and navigation instructions were accessible from the menu on each page. Participants were asked to complete the curriculum within four weeks at their own pace with unlimited video access and were instructed to contact the study team for technical issues. Outcomes and Measures The primary outcome was the feasibility of recruiting participants to complete BB, which was assessed through metrics on recruitment, engagement, and rates of post-assessment completion. Recruitment was measured as the percentage of individuals who expressed interest, were screened, and provided consent. Engagement was measured by assessing the video completion rate and the need for technical support. Video completion rate (videos watched/total videos) was tracked via the learning management system to mitigate potential misclassification bias in program exposure. Support needs were assessed through participant-initiated emails requesting timely course assistance. Post-assessment completion was measured as the percentage of participants who completed secondary outcome assessments at 4 and 12 weeks. Secondary outcomes included changes in bladder symptoms (both clinical and subjective improvements), bladder health knowledge, and self-efficacy, guided by social cognitive theory. This theory emphasizes personal cognitive factors (e.g., bladder health knowledge) and behavioral factors (e.g., self-efficacy) in promoting healthy bladder behaviors and improving symptoms. 18 Clinical improvements were evaluated using the 10-item DVSS, which assesses urinary symptoms, voiding behaviors, bowel habits and stressful life events at baseline, 4 and 12 weeks post-intervention. 13 Subjective improvements were measured by asking parents if they perceived improvement in their child’s symptoms at 4 and 12 weeks after completing BB. Interest in seeking medical care was measured by asking, “ Are you planning to schedule and/or attend a 1-on-1 healthcare provider appointment with your child to discuss their bladder health? ” at baseline and 4 weeks. Parental bladder health knowledge was assessed with an 11-question survey adapted from the National Health and Nutrition Examination Survey (NHANES) and Prevention of Lower Urinary Tract Symptoms Consortium survey, administered at baseline, post-video (after watching each video), and at 12 weeks. 19 , 20 Self-efficacy was measured with the 13-item Parent-Patient Activation Measure (P-PAM), a four-point Likert scale assessing parental knowledge, skills and confidence in managing their child’s health. This was administered at baseline and 4 weeks. 21 The total P-PAM score was calculated on a continuous scale ranging from 0 to 100, categorizing activation into four levels, with higher scores indicating greater activation. 22 , 23 The overall follow-up duration was based on prior trials and study costs. 8 , 9 Sociodemographic data, including social determinants of health, were collected using survey items from NHANES and the Center for Medicare & Medicaid Services Accountable Health Communities Health-Related Social Needs (AHC-HRSN) Screening Tool. 24 The Short Screening Instrument for Psychological Problems in Enuresis (SSIPPE) was used to screen for emotional, attention or hyperactivity/impulsivity issues in children. 25 Supplementary Figure S2 presents the survey deployment across the study time period. Data Analysis To achieve 80% power (α = 0.05) and detect an expected 30% clinical difference in symptom score as demonstrated in prior trials, a sample size of 204 was required. 26 Given the novel, home-based nature of this intervention with no direct comparison, we aimed to recruit 100 participants, similar to prior UT trial cohorts, to estimate effect size for future sample size calculations. 8 , 9 Feasibility metrics, secondary outcomes, and sociodemographic data were analyzed descriptively. Paired t-tests were used for normally distributed variables, non-parametric tests (Wilcoxon and Sign) for non-normally distributed variables, and McNemar’s test for categorical variables. Missing data was addressed using complete-case analysis; participants were only included if they completed the surveys specific to each post-intervention timepoint. Statistical significance was set at p < 0.05, and analyses were conducted using R. RESULTS Recruitment and Post-Assessment Completion From July 2023 to August 2024, 426 families completed screening and 180 (42%) were eligible ( Figure 1 ). Primary ineligibility reasons were: 1) child did not meet DVSS cutoff (159, 65%) with mean ± SD and median (IQR) scores of 5.88 ± 2.69 and 6 (4 - 8) for males, and 4.04 ± 1.99 and 4 (3 - 6) for females, 2) child received special services for developmental needs (48, 20%), and 3) child had structural and neurological abnormalities of the urinary tract (42, 17%). Of the 180 eligible families, 70 (39%) were recruited, with 52 (74%) completing BB, 51 (73%) completing the 4-week survey, and 47 (67%) completing the 12-week survey. Figure 1. Open in a new tab Flow diagram of participants through the study. Participating children were majority aged 5-6 (52%), female (71%), White/European (52%) and screened positive on SSIPPE (89%) ( Table 1 ). The mean ± SD DVSS score was 11.52 ± 3.09 and the median (IQR) was 11.5 (10–13). Most parents were 35 - 44 years old (73%), female (90%), White/European (48%), well-educated (Bachelor’s or higher, 90%), employed full-time (46%), with household incomes ≥ $100k (65%) and met their health-related social needs (64%). No characteristic differences were found between study completers and non-completers ( Supplementary Table S2 ). Table 1. Characteristics of Bladder Basics program completers (n =52) Characteristic n (%) Child’s age 5 14 (27) 6 13 (25) 7 7 (14) 8 8 (15) 9 7 (14) 10 3 (5.8) Child’s gender Female 37 (71) Male 15 (29) Child’s race and ethnicity White or European, not Hispanic or Latino 27 (52) Asian or Asian American, not Hispanic or Latino 16 (31) Hispanic or Latino/a 4 (7.7) American Indian or Alaska Native 1 (1.9) Black or African American, not Hispanic or Latino 1 (1.9) Middle Eastern or North African 1 (1.9) Other 2 (3.8) Parent’s age 25-34 3 (5.8) 35-44 38 (73) 45-54 10 (19) 55-64 1 (1.9) Parent’s gender Female 47 (90) Male 5 (9.6) Parent’s race and ethnicity White or European, not Hispanic or Latino 25 (48) Asian or Asian American, not Hispanic or Latino 21 (40) Hispanic or Latino/a 4 (7.7) Black or African American, not Hispanic or Latino 1 (1.9) Middle Eastern or North African 1 (1.9) Parent’s education level High school graduate 3 (5.8) Associate’s degree: academic program 2 (3.8) Bachelor’s degree 14 (27) Master’s degree 21 (40) Doctoral degree 8 (15) Professional school degree 4 (7.7) Parent’s employment status Employed full-time 24 (46) A homemaker 12 (23) Employed part-time 6 (12) Not employed 4 (7.7) Contract/temporary 1 (1.9) Unable to work for health reasons 1 (1.9) Other 1 (1.9) I prefer to not answer 3 (5.8) Total household income $10k-$14,999 2 (3.8) $15k-$19,999 1 (1.9) $65k-$74,999 1 (1.9) $75k-$99,999 6 (12) $100k and over 34 (65) Prefer to not answer 8 (15) Unmet health-related social needs (screened positive for AHC-HRSN) No 33 (64) Yes 19 (37) Child’s psychological problems (screened positive for SSIPPE) No 6 (12) Yes 46 (89) Child’s constipation symptoms DVSS (Q3 and Q4) Missed bowel movements (less than half the time or more) 35 (67) Pushing for bowel movements (less than half the time or more) 40 (77) Open in a new tab Abbreviations: SSIPPE, Short Screening Instrument for Psychological Problems in Enuresis; DVSS, Dysfunctional Voiding Symptom Score. Engagement Among the 70 enrolled participants, the mean video completion rate was 74% with a median of 100%. Most participants (71%) completed 80% - 100% of the curriculum, while 26% had low completion (0% - 20%) and only 3% engaged at a moderate level (20% - 60%) ( Supplementary Figure S3 ). The most common technology-related issue was accessing course content from the homepage, which was resolved by emailing instructions to participants. Symptom Score DVSS scores decreased significantly by 32% at 4 weeks (−3.98 ± 4.64, 95% CI [−5.29, −2.68], p < 0.001) and 42% at 12 weeks from baseline (−5.26 ± 4.68, 95% CI [−6.63, −3.88], p < 0.001). In exploratory analyses, no significant gender differences were observed at 4 weeks (Female: −4.16 ± 4.32, Male: −3.50 ± 5.54, 95% CI [−3.88, 3.02], p = 0.8) or 12 weeks (Female: −4.83 ± 4.83, Male: −6.50 ± 4.17, 95% CI [−1.34, 4.69], p = 0.3). At 4 weeks, 39% of children fell below the DVSS cutoff criteria ( p < 0.001), increasing to 55% at 12 weeks ( p < 0.001). Subjective improvement was reported as “a little better” by 55% at 4 weeks and 38% at 12 weeks, and “much better” by 22% at 4 weeks and 36% at 12 weeks. Parents feeling no need for a clinic visit increased from 45% at baseline to 69% at 4 weeks ( p = 0.002) ( Table 2 ). Table 2. Symptom scores in children. Baseline vs. 4-Weeks (n = 51) Baseline vs. 12-Weeks (n = 47) Baseline 4-Weeks Baseline 12-Weeks Overall DVSS Score Change Mean Score Change ± SD Paired n p Mean Score Change ± SD Paired n p Overall −3.98 ± 4.64 51 <0.001 a −5.26 ± 4.68 47 <0.001 a Female −4.16 ± 4.32 37 0.8 b −4.83 ± 4.83 35 0.3 b Male −3.50 ± 5.54 14 −6.50 ± 4.17 12 DVSS Score Change by Question (Non-Zero Pairs Only) Median Score Change (IQR) Paired n p Median Score Change (IQR) Paired n p Q1: My child has had wet clothes or wet underwear during the night. −1 (−2, −1) 18 <0.001 c −1 (−2, −1) 15 <0.001 c Q2: When my child wets themselves, their underwear is soaked. −1 (−2, −1) 13 0.019 c −1 (−2.25, −1) 20 0.006 c Q3: My child misses having a bowel movement every day. −1 (−1, −1) 29 0.006 c −1 (−1, −1) 29 <0.001 c Q4: My child has to push for their bowel movements to come out. −1 (−2, 0) 31 <0.001 c −1 (−2, −1) 32 <0.001 c Q5: My child only goes to the bathroom one or two times each day. −1 (−1.75, 1) 26 0.2 c −1 (−2, −1) 21 0.002 c Q6: My child can hold onto their pee by crossing their legs, squatting or doing the “pee dance”. −1 (−2, 1) 33 0.12 c −1 (−2, 1) 31 0.046 c Q7: When my child has to pee, they cannot wait. −1 (−2, −1) 32 <0.001 c −2 (−2, −1) 31 <0.001 c Q8: My child has to push to pee. −1 (−2.25, −1) 16 0.006 c −1 (−2.5, −1) 15 <0.001 c Q9: When my child pees it hurts. −1 (−1, −1) 12 0.006 d −1 (−1, −1) 11 0.012 d n (%) n (%) p n (%) n (%) p LUTS Negative 0 (0) 20 (39) <0.001 e 0 (0) 26 (55) <0.001 e Not Seek Medical Care 23 (45) 35 (69) 0.002 e / / / Subjective Improvement: LUTS Since Completing Bladder Basics / n (%) / / n (%) / A little worse / 1 (2) / / 0 (0) / No change / 7 (14) / / 3 (6.4) / A little better / 28 (55) / / 18 (38) / Much better / 11 (22) / / 17 (36) / Very much better / 4 (7.8) / / 9 (19) / Open in a new tab Abbreviation: DVSS, Dysfunctional Voiding Symptom Score; LUTS, Lower Urinary Tract Symptoms. a Paired t-test b Unpaired t-test to evaluate difference in score change between female and male sex at 4-weeks and 12-weeks c Wilcoxon signed-rank test d Sign test e McNemar’s test Bladder Health Knowledge Overall bladder health knowledge significantly increased, with a median change of 1 question (IQR: 1 - 2; p < 0.001) post video and at 12 weeks ( Table 3 ). Questions with the highest percentage improvement were, “ What do you think of the following statement? Poop is related to bladder health ” (73% to 98% post-video, p < 0.001; 75% to 100% at 12 weeks, p < 0.001) and “ How often should your child pee? ” (73% to 98.1% post-video, p < 0.001; 72% to 98% at 12 weeks, p < 0.001). Table 3. Bladder health knowledge in parents. Baseline vs. Post-Video (n = 52) Baseline vs. 12-Weeks (n = 47) Baseline Post-Video Baseline 12-Weeks Overall Knowledge Score (Non-Zero Pairs Only) Median Score Change (IQR) Paired n p Median Score Change (IQR) Paired n p 1 (1, 2) 33 <0.001 a 1 (1, 2) 27 <0.001 b Correct Reponses by Question n (%) n (%) p n (%) n (%) p Q1: Which of the following does the bladder do? 50 (96) 52 (100) 0.5 c 45 (96) 47 (100) 0.5 c Q2: In the figure below, please choose the letter that represents the bladder. 52 (100) 52 (100) NA c 47 (100) 47 (100) NA c Q3: What do you think of the following statement? The brain is related to bladder health. 45 (87) 47 (90) 0.5 c 41 (87) 45 (96) 0.13 c Q4: Which of the following is a sign of an unhappy bladder? 48 (92) 51 (98) 0.3 c 43 (92) 47 (100) 0.13 c Q5: Which of the following causes an unhappy bladder? 51 (98) 52 (100) 1 c 46 (98) 47 (100) 1 c Q6: What do you think of the following statement? Poop is related to bladder health. 38 (73) 51 (98) <0.001 c 35 (75) 47 (100) <0.001 c Q7: What occurs when poop becomes hard, dry, infrequent, and/or difficult to pass. 51 (98) 52 (100) 1 c 46 (98) 45 (96) 1 c Q8: How often SHOULD your child pee for good health? 38 (73) 51 (98) <0.001 c 34 (72) 46 (98) <0.001 c Q9: Which of the following can improve poop health? 42 (81) 47 (90) 0.063 c 38 (81) 43 (92) 0.063 c Q10: Which of the following can improve bladder health? 50 (96) 52 (100) 0.5 c 45 (96) 46 (98) 1 c Q11: Which of the following plans can improve bladder health? 45 (87) 51 (98) 0.031 c 42 (89) 43 (92) 1 c Open in a new tab a Wilcoxon signed-rank test b Sign test c McNemar’s test Self-Efficacy The mean ± SD and median (IQR) P-PAM scores at baseline were 63.12 ± 16.82 and 58.1 (48.9 - 75), which increased to 70.84 ± 17.16 and 67.8 (55.6 - 84.8) at 4 weeks. There is an overall upward trend in P-PAM levels from baseline to 4 weeks, with fewer participants in levels 1 and 2 and more in levels 3 and 4 at follow-up ( Supplementary Figure S4 ). This trend was further confirmed by a sign test, which shows a statistically significant improvement with a median change of 4.6 points (IQR: −3.75 - 19.25; p = 0.018). DISCUSSION Bladder Basics addresses a gap in accessible bladder health education with an evidencebased, publicly available resource for children aged 5-10 years and their families. Its online and digital format offers a low-cost, scalable solution with the potential to promote behavioral change and symptom improvement at a population level outside a clinical environment. 9 , 27 In this pilot study, we found strong interest in the study and overall improvements in LUTS symptom scores, bladder health knowledge and self-efficacy. Strong interest in participation (426 families) and the enrollment of 70 families is likely due to the flexibility of an online format, which avoids the clinical and scheduling barriers noted in prior UT trials. 8 , 9 The mean DVSS scores of 159 patients excluded specifically due to DVSS (5.88 for males, 4.04 for females) highlight a symptomatic population that, while not meeting strict clinical criteria, may still benefit from a low-cost, low-risk education program. Overall engagement was high, and most participants did not report technology issues as a barrier to participation, though low digital literacy, limited internet access, and data safety concerns remain ongoing challenges for online health intervention. 28 Clinical symptom improvement of a 5.62-point decrease in DVSS is comparable to outcomes from previous UT trials, 8 , 9 with almost all families reporting subjective improvement. From a behavioral change framework perspective, social cognitive theory posits that individual factors, such as knowledge of bladder health, “normal” expectations for bathroom use, and skills of how to navigate bathroom use, can impact subsequent action leading to clinical improvement. 18 Improvements in self-efficacy and overall knowledge of key UT concepts - peeing every 3 hours and bowel health awareness - can be further studied in future trials to delineate drivers of change. Question 5 of the DVSS, asking participants how often their child voided improved, points to preliminary evidence that BB can impact behaviors. In the absence of quantitative measurements, perception or subjective improvement remains an important metric in LUTS-related patient-centered outcomes and quality of life. 29 Additional studies recruiting a more diverse group of patients and focusing on implementation are needed to outline the support required for the widespread adoption of the program. This study has demonstrated that the program is impactful for symptomatic patients who would typically seek medical care for symptoms; 13 however, we noted a large interest in a population just below the DVSS cutoff score who would likely benefit from the program. Our primary population was White and well-educated, which may have led to the relative absence of technology issues and overall high baseline knowledge scores. Recruiting a more heterogeneous population may provide additional insight into the program’s overall effectiveness on a larger scale and identify early implementation needs, especially for a population-level intervention that may require smaller effect sizes to demonstrate efficacy. Besides individual outcomes, it may be of interest to measure healthcare utilization (primary care, sub-specialty referrals) as an increased number of families responded that they would defer medical care after using our program. Limitations Our cohort characteristics limit the generalizability of the findings, as our population was primarily White, well-educated, and had a higher rate of positive SSIPEE compared to the literature. 30 Additional social factors such as school schedules and family routines, may influence symptom and knowledge outcomes based on enrollment timing and intervention completion. Bladder diaries were not collected to avoid high participant burden and low completion rates but may be useful in future studies. CONCLUSION This pilot study demonstrated the feasibility of recruiting participants to complete BB and its effectiveness in improving bladder symptoms and knowledge. Strong participant interest and high program engagement highlight the potential for adoption in populations with both mild and severe symptoms. This study represents a critical step in reframing UT from a clinical treatment within the healthcare system to a scalable, community-level public intervention. Supplementary Material 1 Supplementary Figure S1. Bladder Basics banner with cast of characters and interface for online learning platform website. NIHMS2091512-supplement-1.pdf (222.7KB, pdf) 2 Supplementary Figure S2. Survey deployment timeline across study. NIHMS2091512-supplement-2.pdf (29.8KB, pdf) 3 Supplementary Figure S3. Distribution of video completion rates among participants. NIHMS2091512-supplement-3.pdf (88.4KB, pdf) 4 Supplementary Figure S4. P-PAM level trends from baseline to 4 weeks. NIHMS2091512-supplement-4.pdf (202.5KB, pdf) 5 Supplementary Table S1. Bladder Basics video titles and educational objectives. NIHMS2091512-supplement-5.docx (15.5KB, docx) 6 Supplementary Table S2. Characteristics comparison of study (12-Week Survey) completers (n = 47) and non-completers (n = 23) NIHMS2091512-supplement-6.docx (20.7KB, docx) Acknowledgements: We would like to acknowledge Rachelle Balili, MS and Chiyuan (Amy) Zhang, MPH for their contribution to this research study. Funding: This work was supported by the National Institute Of Diabetes And Digestive And Kidney Diseases of the National Institutes of Health [grant numbers K12DK137162]; 2023 SPU Research Grant from the Societies for Pediatric Urology. GLOSSARY LUTS Lower Urinary Tract Symptoms DUI Daytime Urinary Incontinence UTI Urinary Tract Infection UT Urotherapy ICCS International Children’s Continence Society BB Bladder Basics DVSS Dysfunctional Voiding Symptom Score P-PAM Parent-Patient Activation Measure NHANES National Health and Nutrition Examination Survey AHC-HRSN Accountable Health Communities Health-Related Social Needs SSIPPE Short Screening Instrument for Psychological Problems in Enuresis Footnotes Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Declaration of Competing Interest The authors have no conflicts of interest relevant to this article to declare. Declaration of Generative AI and AI-assisted technologies in the writing process The authors did not use generative AI or AI-assisted technologies in the development of this manuscript Data Availability Statement: The data sets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request. REFERENCES 1. Swithinbank L, Heron J, Von Gontard A, Abrams P. The natural history of daytime urinary incontinence in children: a large British cohort. 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Bladder Basics banner with cast of characters and interface for online learning platform website. NIHMS2091512-supplement-1.pdf (222.7KB, pdf) 2 Supplementary Figure S2. Survey deployment timeline across study. NIHMS2091512-supplement-2.pdf (29.8KB, pdf) 3 Supplementary Figure S3. Distribution of video completion rates among participants. NIHMS2091512-supplement-3.pdf (88.4KB, pdf) 4 Supplementary Figure S4. P-PAM level trends from baseline to 4 weeks. NIHMS2091512-supplement-4.pdf (202.5KB, pdf) 5 Supplementary Table S1. Bladder Basics video titles and educational objectives. NIHMS2091512-supplement-5.docx (15.5KB, docx) 6 Supplementary Table S2. Characteristics comparison of study (12-Week Survey) completers (n = 47) and non-completers (n = 23) NIHMS2091512-supplement-6.docx (20.7KB, docx) Data Availability Statement The data sets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request. 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