INTRODUCTION
Lower urinary tract symptoms (LUTS) comprise a common group of urological disorders that increase in prevalence with age and substantially impair patients’ quality of life [1]. LUTS include urinary frequency, nocturia, urgency, and delayed urination [2], and therefore necessitate persistent, long-term management. For the clinical diagnosis of these symptoms and the evaluation of treatment efficacy, the voiding diary is regarded as a key noninvasive and objective tool for documenting patients’ voiding patterns and lifestyle habits [3]. Nevertheless, in clinical practice, barriers such as inconvenience, tediousness, and frequent discontinuation have been consistently reported, hindering sustained use [4]. These limitations restrict the utility of voiding diaries despite their recognized clinical value. While previous studies have primarily addressed compliance issues, the present study aims to provide a structural analysis of long-term changes in social perceptions and experiences surrounding voiding diaries, including their constraints.
This study analyzed long-term changes in public discourse about voiding diaries by collecting 10 years of online community data from September 1, 2015, to August 31, 2025. Online communities serve as venues where patients and the general public share experiences related to urination and openly discuss the challenges associated with diary completion, making them valuable sources for understanding social perceptions and experiential contexts. Accordingly, this study seeks to structurally examine these long-term perceptual changes and to provide empirical evidence regarding barriers to compliance as well as the broader social utility of voiding diaries.
Theoretical Background
Clinical applications and significance of voiding diaries
A voiding diary is a quantitative tool that records not only voiding times and volumes but also incontinence episodes, pad usage, and fluid intake, thereby providing a comprehensive assessment of voiding patterns and related symptoms [5]. In patients with overactive bladder, a 7-day voiding diary has demonstrated excellent reliability (intraclass correlation coefficient 0.81–0.86) for evaluating symptoms such as urgency, daytime and nighttime voiding, and urge incontinence [6]. The Lower Urinary Tract Dysfunction Research Network cohort further showed that a 3-day voiding diary achieved over 50% completion in both research and clinical settings, supporting its feasibility as a practical recording method [7]. In addition, studies on nocturia patients have reported that nocturnal voiding diaries enable systematic evaluation of nocturnal voiding patterns and changes in bladder function [8]. Collectively, these findings indicate that the voiding diary has evolved beyond a simple self-report instrument to become a core clinical tool for objectively assessing symptom variability and treatment outcomes.
Compliance issues and limitations of voiding diaries
Although voiding diaries are clinically valuable assessment tools, patient compliance is often low and record completeness inadequate due to the time and cognitive burden of the recording process [5]. Many patients perceive the continuous documentation of voiding times, volumes, and fluid intake as burdensome, leading to omissions or discontinuation [7]. Evidence also indicates that diary accuracy declines over time, with essential parameters such as urine volume and nocturia increasingly recorded in an incomplete manner [9]. These deficiencies reduce the reliability of clinical interpretation and limit their usefulness in diagnosis and treatment evaluation. To maximize the clinical value of voiding diaries, supplementary strategies are needed to reduce recording burden and improve patient adherence.
Improving compliance through digital voiding diaries and gamification
The recent proliferation of digital therapeutics using smartphone applications and wearable devices has created new opportunities to reduce the burden of manual recording and to improve the management of voiding-related data through automated logging and notification features [10]. Clinical evaluations have demonstrated that smartphone-based voiding diary applications alleviate the burden of documentation by providing simple input and storage functions for voiding times and volumes, while also improving the efficiency of data sharing with healthcare providers [11]. In pediatric populations, mobile voiding diary applications have shown superior data quality compared to traditional paper-based methods, particularly with regard to readability and real-time recording rates [12]. These findings provide empirical support for the feasibility of digitizing voiding diaries. In parallel, gamification —an approach increasingly applied in healthcare — is being explored as a strategy to transform repetitive and tedious recording tasks into engaging and motivating experiences [13]. Scoring, visual feedback, and the presentation of step-by-step goals positively influence long-term record maintenance by reinforcing user engagement motivation, thereby supporting sustained participation in repetitive self-monitoring contexts [14, 15].
MATERIALS AND METHODS
Research Design
Text mining techniques were applied to transform unstructured online text data into structured information [16]. Online community data were collected using the Textom platform (www.textom.com) to enhance the efficiency of data acquisition and analysis. Changes in major keywords and public discourse related to voiding diaries were examined through time-series and 2-gram analyses, while TF-IDF analysis was additionally employed to identify salient themes from multiple perspectives. The overall data analysis procedure consisted of 3 stages: (1) data collection, (2) data preprocessing, and (3) data analysis and visualization, as illustrated in Fig. 1 [17].
Data Collection and Refinement
Data were collected over a 10-year period, from September 1, 2015, to August 31, 2025, using the keywords “voiding diary,” “voiding log,” “bladder diary,” and “bladder log.” The selection of these keywords reflected the observation that while the term “voiding diary” is primarily used in clinical contexts, online discussions often employ alternative expressions such as “voiding log” and “bladder diary.” Including all related terms enabled a comprehensive representation of public discourse. The 10-year timeframe was deliberately chosen to capture long-term shifts in social perception rather than short-term fluctuations. Data were collected from Naver (Blog, Cafe, Knowledge iN) and Daum (Tistory, Cafe), the platforms with the largest active user bases in Korea. The collection scope encompassed titles, body text, and URLs, resulting in a final dataset of approximately 26.9 MB. MeCab was used as the morphological analysis tool, and the analysis included nouns, verbs, and adjectives. During data preprocessing, unnecessary symbols and characters were removed, duplicate entries were excluded when titles and body text fully matched, and commercial or advertising content was filtered through stopword processing.
Analysis Methods
Time-series analysis
Time-series analysis is a technique that accounts for the continuity of data over time to identify patterns, detect trends, and understand long-term fluctuations [18]. Online community data from the past decade were aggregated on a monthly basis to measure sustained changes in the volume of mentions. The data were also separated and compared across platforms to evaluate differences in contribution between primary and secondary discussion channels. This approach enabled the identification of periods with increased mention volume and provided a foundation for interpreting these surges within relevant external contexts. Time-series analysis thus offered evidence for explaining shifts in social perception and fluctuations in public interest related to urinary diaries.
Two-gram analysis
Two-gram analysis measures the frequency of 2 words appearing consecutively within a text to identify associated concepts that recur alongside specific keywords [19]. For the preprocessed community data, 2-gram combinations were calculated with a focus on vocabulary related to voiding diaries. Items with high occurrence frequencies were selected to extract core concepts mentioned concurrently with voiding diaries. The resulting 2-gram combinations also revealed interword connection structures, providing foundational data to confirm the semantic domains in which discussions on voiding diaries were concentrated.
TF-IDF analysis
Term frequency-inverse document frequency (TF-IDF) analysis is a technique that evaluates the relative importance of a word by combining its frequency of occurrence with its rarity across the entire document collection [20]. Community data were divided into subsets by period and platform, and TF-IDF values were calculated to extract core words that appeared prominently within each subset. This process identified words carrying specific meanings that might otherwise be underestimated or overlooked in simple frequency analysis. Furthermore, TF-IDF highlighted keywords selectively emphasized during particular periods and across different platforms, providing complementary evidence for interpreting contextual differences in the discussions.
RESULTS
Time-Series Analysis Results
The time-series analysis showed a marked increase in the total number of mentions, rising from an average of approximately 1,843 cases in the early period (2015–2018) to an annual average of about 3,736 cases in the mid-term period (2019–2021). In the late period (2022–2025), the volume reached a stable level, with an annual average of approximately 4,061 mentions, peaking in 2024 at around 4,250 mentions. The corresponding time-series graph is presented in Fig. 2.
Naver Blog accounted for more than 70% of the total mentions, serving as the main platform for discussions about voiding diaries. Naver Cafe (annual average of about 499 posts) and Knowledge iN (annual average of about 140 posts) maintained steady contributions despite their smaller scale, while Daum Cafe and Tistory contributed only marginally. This distribution indicates that discourse surrounding voiding diaries primarily formed and consolidated on platforms oriented toward personal experience sharing and record keeping.
Two distinct periods of growth were identified in 2016 (A) and 2019 (B). The increase observed in 2016 (A) likely reflected the early spread of health information blogging and medical awareness campaigns, whereas the surge in 2019 (B) may have been driven by heightened interest in digital healthcare and the introduction of recording applications such as the urine diary PRIVY [21]. These surges are interpreted not as temporary peaks triggered by single events but as phases of acceleration within a broader diffusion process. Accordingly, discussions about voiding diaries can be conceptualized as developing through a 3-stage structure: diffusion of awareness, acceleration, and stable establishment.
Two-Gram Analysis Results
The 2-gram analysis generated a total of 513,801 word combinations from the community data. The 20 most frequent keywords are presented in Fig. 3.
Within the 2-gram network, the combinations “voiding-diary” and “diary-recording” appeared most frequently, indicating that voiding diaries are strongly associated with acts of recording and documentation. Prominent combinations with clinical or disease-related terms included “overactive-bladder,” “urine-test,” “uro-dynamic,” and “voiding-disorder.” The pairs “medication-treatment,” “treatment-method,” and “lifestyle-habits” represented the behavioral management category, while “medical history-taking” reflected the category of clinical history and evaluation. These patterns suggest that discourse concerning voiding diaries is organized around 4 primary semantic categories: recording and documentation, clinical evaluation, lifestyle and treatment management, and disease or organ terminology.
TF-IDF Analysis Results
The TF-IDF analysis calculated weights for all 40,353 words, identifying core keywords with relatively high values. The top 20 keywords derived from this analysis are presented in Table 1.
The leading terms included “examination,” “treatment,” “voiding,” “urine,” “diary,” “bladder,” “overactive,” “documentation,” and “management.” Unlike simple frequency analysis, these terms reflect the central topics of voiding diary discussions within specific timeframes and contexts. “Examination,” “treatment,” and “diagnosis” illustrate the close integration of voiding diaries into clinical practice, while “recording,” “documentation,” “management,” and “habits” represent the context of daily practice and patient compliance. The top-level derivation of repetitive behavior-centered keywords indicates that accumulated fatigue and reduced compliance during the maintenance of voiding diaries function as major experiential barriers. This finding supports the need for design interventions that lessen the burden associated with recurring documentation. Furthermore, prior research reports that gamification elements can facilitate sustained long-term participation in self-recording-based health management tools by reinforcing user engagement motivation [22]. Additionally, disease-related keywords such as “bladder,” “overactive,” “urinary incontinence,” and “prostate” indicate that voiding diaries are directly connected to the management and diagnosis of specific conditions. Collectively, these findings reinforce the patterns observed in the time-series and 2-gram analyses, demonstrating that the voiding diary has established itself in social discourse not only as a recording instrument but also as a dual-purpose tool that integrates medical utility with lifestyle management.
DISCUSSION
Social perceptions and usage patterns of voiding diaries were analyzed through time-series analysis, 2-gram analysis, and TF-IDF analysis of online community data spanning 10 years, from September 2015 to August 2025.
The time-series analysis revealed a long-term trend in which mentions related to voiding diaries increased sharply after 2019 and subsequently stabilized, indicating that voiding diaries have become a continuously discussed topic rather than a transient point of interest. The 2-gram analysis identified 4 semantic categories: recording behavior, clinical context, lifestyle management, and medical history and evaluation. The TF-IDF analysis demonstrated that these categories were differentially emphasized across specific periods and platforms. Taken together, these findings confirm that voiding diaries hold social significance not only in clinical utility but also in lifestyle and disease management, extending well beyond their role as simple recording tools.
Based on these results, several recommendations can be made. First, strategies that ensure continuity in the recording process are essential to enhance clinical utility. Functional measures such as automated reminders, data visualization, and feedback mechanisms are needed to mitigate declining compliance during repeated recording. Second, gamification techniques may be applied to promote long-term persistence in diary use, but these approaches require systematic evaluation. Scoring systems, reward structures, and stepwise incentives can increase patient motivation and thereby improve adherence. Third, given that voiding diaries are closely linked to clinical practice and disease management, their deeper integration will be a critical task in the future development of voiding diary–based digital health platforms.
This study is significant in that it quantitatively analyzed long-term trends and structural characteristics of social discussions related to voiding diaries using Korean online community data. Nevertheless, certain limitations must be acknowledged. The dataset was restricted to a specific country and limited to a few platforms, and the analysis relied primarily on quantitative text mining methods. Future investigations should incorporate multilingual and multi-platform comparisons combined with qualitative approaches to more comprehensively capture the experiential and emotional dimensions of patient perspectives. Furthermore, validating the clinical effectiveness of digital therapeutics and gamification-based interventions among actual patient populations will be essential for advancing voiding diaries into practical, evidence-based therapeutic applications.
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