Community-based Nursing: Continence Care for Older Rural Women Molly C. Dougherty, PhD, RN Jeffrey W. Dwyer, PhD Jane F. Pendergast, PhD Barbara U. Tomlinson, MSN, RN Alice R. Boyington, PhD, RN W. Bruce Vogel, PhD R. Paul Duncan, PhD Raymond T. Coward, PhD Cheryl L. Cox, PhD, RN* The current emphasis on community-based health care makes necessary the implementation and evaluation of nursing practice models that address specific health problems, such as urinary incontinence, of older women living at home in rural communities. T h e emphasis on contemporary community-based health care has stimulated the development of nursing practice models to guide the provision of services and to study the effect of nursing interventions in community settings. The nursing research described in this article illustrates the application of one such model and may be useful in the develop- ment of other community-based projects. The nursing practice model called the Supported by research grant No. R01 NR3139 (Nursing Model: Urinary Continence for Older, Rural Women) from the National Institute of Nurs- ing Research, National Institutes of Health (1992- 1998). *Consultants to the project were Dr Cheryl Cox, University of Massachusetts at Lowell, Dr Jean Wyman, University of Minnesota, Minneapolis, and Dr Regula Herzog, University of Michigan, Ann Arbor. Nurs Outlook 1998;46:233-44. Copyright © 1998 by Mosby, Inc. 0029/6554198/$5.00 + 0 3511191709 Interaction Model of Client Health Be- havior (IMCHB) 1,2 guided the concep- tualization of background variables, the process evaluation of the intervention, and the evaluation of health outcomes. The overall objective of the research was to test an intervention called Behavioral Management for Continence (BMC), which assists older rural women in man- aging urinary incontinence while they are living at home. This 5-year project used a quasi-experi- mental design, tested a nursing interven- tion grounded in the research literature, and engaged rural communities at aggre- gate and individual levels. The aims of the project were to: (1) describe and evaluate processes and outcomes associated with a nursing practice model; (2) evaluate model-specific factors and individual and social context characteristics that are as- sociated with goal attainment and urinary variables; and (3) conduct a cost-effec- tiveness analysis that compares BMC with community and institutional services (Box 1). Participants in the study were older women who lived in rural North Florida and had involuntary urine loss at least twice a week; these women partici- pated in the study for as long as 2 years. The objectives of this article are to: (1) describe the study, (2) discuss measure- ment issues and procedures, (3) report findings on baseline characteristics in light of the related literature, and (4) highlight the application of the IMCHB in the project. BACKGROUND LITERATURE Urinary incontinence, defined as involun- tary urine loss at least weekly, is both preva- lent and costly. Among noninstitutionalized Urinary incontinence, defined as involuntary urine loss at least weekly, is both prevalent and costly. persons aged 60 years and older, the preva- lence of urinary incontinence is between 15% and 35%, with women having twice the prevalence of men. Urinary inconti- NURSING OUTLOOK SEPTEMBER/OCTOBER 1998 Dougherty et al 233