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Development and Validation of an Instrument to Assess Women's Toileting Behavior Related to Urinary Elimination: Preliminary Results

Wang, Kefang; Palmer, Mary H.

doi: 10.1097/NNR.0b013e3182159cc7

Background: Toileting behaviors have been implicated in women's bladder health; however, the lack of a standardized instrument to explore variations in women's toileting behaviors has contributed to an incomplete understanding about the effects of these behaviors on bladder health.

Objectives: The aims of this study were to develop and initially validate an instrument, the Web-based Toileting Behavior (TB-WEB) scale, to assess behaviors women use when emptying their bladders.

Methods: An initial 41-item instrument was developed after a comprehensive literature review and a concept analysis of women's toileting behavior related to urinary elimination. Seven experts with clinical or research experience in women's bladder health were selected to evaluate the content validity of each item and of the entire instrument. The psychometric properties of the TB-WEB scale were assessed using a Web-based survey with community-dwelling middle-aged women from June to August 2009. Construct validity and internal consistency were measured.

Results: An 18-item scale was developed. Principal component analysis with varimax rotation revealed 5 underlying factors that explained 67% of the variance. Internal consistency reliabilities of the 5 subscales ranged from .70 to .88. The 5 subscales were premature voiding (5 items), straining voiding (4 items), place preference for voiding (4 items), delayed voiding (3 items), and position preference for voiding (2 items).

Discussion: The TB-WEB scale shows reliability and initial validity to assess women's toileting behavior related to urinary elimination in community-dwelling middle-aged women. However, further testing is needed in other community-dwelling populations, as well as with hospitalized women, to strengthen its generalizability and to address areas for improvement.

Kefang Wang, PhD, RN, is Associate Professor, School of Nursing, Shandong University, Jinan, People's Republic of China.

Mary H. Palmer, PhD, RNC, FAAN, is Helen W. and Thomas L. Umphlet Distinguished Professor in Aging, School of Nursing, University of North Carolina at Chapel Hill.

Accepted for publication January 5, 2011.

Thank you to Dr. Mary Lynn for her thoughtful suggestions in instrument content validation and her invaluable feedback on an earlier draft of this manuscript. Thank you also to Dr. Teresa Edwards and Dr. Cathy Zimmer for their consultation on survey development and data analysis and the University of North Carolina Odum Institute for providing software to develop our Web-based survey.

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Corresponding author: Kefang Wang, PhD, RN, School of Nursing, Shandong University, Jinan, Shandong, 250012 People's Republic of China (e-mail:

© 2011 Lippincott Williams & Wilkins, Inc.