Pelvic‐floor‐muscle‐training adherence “modifiers”: A review of primary qualitative studies—2011 ICS State‐of‐the‐Science Seminar research paper III of IV

Abstract

AimsThis review aims to locate and summarize the findings of qualitative studies exploring the experience of and adherence to pelvic floor muscle training (PFMT) to recommend future directions for practice and research. MethodsPrimary qualitative studies were identified through a conventional subject search of electronic databases, reference-list checking, and expert contact. A core eligibility criterion was the inclusion of verbatim quotes from participants about PFMT experiences. Details of study aims, methods, and participants were extracted and tabulated. Data were inductively grouped into categories describing "modifiers" of adherence (verified by a second author) and systematically displayed with supporting illustrative quotes. ResultsThirteen studies (14 study reports) were included; eight recruited only or predominantly women with urinary incontinence, three recruited postnatal women, and two included women with pelvic organ prolapse. The quality of methodological reporting varied. Six "modifiers" of adherence were described: knowledge; physical skill; feelings about PFMT; cognitive analysis, planning, and attention; prioritization; and service provision. ConclusionsIndividuals' experience substantial difficulties with capability (particularly knowledge and skills), motivation (especially associated with the considerable cognitive demands of PFMT), and opportunity (as external factors generate competing priorities) when adopting and maintaining a PFMT program. Expert consensus was that judicious selection and deliberate application of appropriate behavior change strategies directed to the "modifiers" of adherence identified in the review may improve PFMT outcomes. Future research is needed to explore whether the review findings are congruent with the PFMT experiences of antenatal women, men, and adults with fecal incontinence.

Health professionals’ and patients’ perspectives on pelvic floor muscle training adherence—2011 ICS State‐of‐the‐Science Seminar research paper IV of IV

“…The smaller public‐cohort dataset is potentially less representative. Responses highlighted important findings in PFMT adherence determinants that generally supported the existing (predominantly UI‐focused) literaturebut also identified important new findings. Support was found for the importance of self‐efficacy.…”

“…In contrast to published findings, symptom severity was not ranked highly as an adherence facilitator (i.e., the more severe the condition, the more adherent to PFMT). Patient self‐efficacy, identified as a PFMT adherence determinant in previous studiesranked more highly with the public than health professionals.…”

2014 consensus statement on improving pelvic floor muscle training adherence: International Continence Society 2011 State‐of‐the‐Science Seminar

“…Twelve of the 13 studies recruited only women. The six modifiers generated by the thematic analysis were: knowledge; physical skill; feelings about PFMT; cognitive analysis, planning and attention; prioritisation; and service provision …”

“…Determinants of exercise adherence can be subdivided into moderators (e.g., age, gender—so not amenable to change through an intervention) and mediators (e.g., self‐efficacy—which is amenable to change). Our search focused on known mediators to PFMT adherence and we also discuss modifiers (that have potential to influence adherence but have yet to be investigated in experimental or observational research) . Adherence strategies include any method or combination thereof designed to improve PFMT adherence (e.g., reminder methods: alarms, diaries) as well as other behavioral strategies (e.g., goal setting) …”

Scoping review of adherence promotion theories in pelvic floor muscle training – 2011 ics state‐of‐the‐science seminar research paper i of iv

“…The COM‐B is at the centre of a behavior change wheel with a second circle, comprising nine intervention functions, supporting behavior change: education, persuasion, incentivisation, coercion, training, enablement, modelling, environmental restructuring, and restrictions. Four of these have been shown to be important in PFMT: education, training, persuasion, and enabling …”