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- PURI-PRO (Portuguese URinary Incontinence PROject) – Sympton Impact Ande Health Intervention For Midde-Aged Women With Urinary IncontinencePublication . Porto, Marta Monteiro da Silva Gonçalves; Pimenta, FilipaUrinary incontinence (UI) is highly prevalent yet frequently undertreated and underreported, imposing substantial biopsychosocial costs during midlife. Many women are socially active through defensive and hiding self-management coping strategies that provide short-term control but delay help-seeking. The PURI-PRO was designed as a sequential three-phase, mixed-methods investigation to understand the UI cognitive, emotional, and behavioural dimensions, and their interconnections through the lens of the Common-Sense Model (CSM); the role of beliefs and coping in UI psychosocial consequences; and to test an eHealth intervention. Participants were Portuguese women aged 40–65 years who were recruited online using snowball sampling and self reported occasional and frequent UI. Phase 1 employed a qualitative, quantitative and cross sectional design (Objective 1; n = 34) to explore illness representations, emotions, and coping, as well as their interconnectedness, through directed content and textual analysis. The Portuguese Brief Illness Perception Questionnaire (Brief IPQ) was validated (Objective 2; n = 1,511). Phase 2 consisted of cross-sectional studies (Objectives 3–8; n = 1,538–2,648) to validate the KHQ Symptom Severity Subscale (KHQ-SSS), develop the UI-Self-Management Coping Strategies Instrument (UI-SMCSI) and UI-Social Isolation Questionnaire (UI-SIQ), and test mediation (role of UI-SMC in the relationship between symptom severity and social isolation) and moderation (coping and beliefs buffering UI severity impact on sexual function/quality of life [QoL]). The impact of UI severity on workplace productivity was also explored. Structural Equation Modelling and measurement invariance were applied. Phase 3 was a 1:1 randomised controlled trial (Objectives 9–10; EG = 46, CG = 52) of an eight-week synchronous eHealth intervention grounded in the CSM, the Health Action Process Approach (HAPA), and Cognitive–Behavioural Therapy (CBT), using BCTTv1 behaviour change techniques. Outcomes were assessed at baseline, mid intervention, post-intervention, and follow-up using Conditional Latent Growth Modelling, with mediation analyses testing the role of risk perception and intention in the relationship between symptom severity and primary outcomes at follow-up. Phase 1 (Objectives 1–2) identified two largely independent dimensions—cognitive illness representations and behavioural strategies—with peripherally-located emotions. An appraisal mechanism linked control and timeline beliefs to coping, suggesting an extension of the CSM. In Phase 2 (Objectives 3–8), coping buffered the effect of UI severity on sexual function, whereas beliefs did not. Severity, beliefs and coping strategies directly impacted QoL. Coping fully mediated the association between symptoms’ severity and social isolation. Workplace productivity was also negatively impacted by UI severity. Phase 3 (Objectives 9–10) showed that the intervention reduced symptom severity, threatening illness representations, and defensive/hiding coping; improved condition-specific QoL and social isolation; and strengthened volitional self-regulation. Planning and action control mediated the pathway from early motivation to outcomes. In conclusion, PURI-PRO reframes UI as a multi determined clinical and changeable condition in which beliefs set the context, appraisals channel beliefs into behaviour, coping functions as mediator and moderator of psychosocial outcomes, while volition counterbalances the adverse effects of risk perception and intention. Contributions include an extension of the CSM, the development of three brief condition-specific PROMs, and experimental evidence that combining physiotherapy with evidence-based Health Psychology models in multidisciplinary teams enhances UI care and condition-specific QoL.