Abstract
Background: Urinary incontinence (UI) is a prevalent health problem in women worldwide, especially in pregnant women. Supervised pelvic floor muscle training (PFMT) is recommended as the first-line conservative treatment for UI. However, the implementation and effectiveness of PFMT are limited by insufficient human resources and low adherence. Group-based interventions may improve people’s adherence to interventions by facilitating peer support and are non-inferior to individualized PFMT in reducing urine leakage in older women. However, it has been investigated in a limited number of maternity studies. This study aims to adapt the context of group-based PFMT for pregnant women in China and facilitate women’s adherence to the PFMT programme.Methods: This study was guided by the Medical Research Council framework for complex interventions and the Behaviour Change Wheel guide to developing interventions. A three-phase, mixed-methods design was used in this study. The first phase is a systematic review (the first publication) which aimed to answer the effectiveness of group-based PFMT in preventing and treating UI in antenatal and postnatal women. The potential barriers and facilitating characteristics of group-based PFMT that influence the success of the group-based intervention were also explored in the review. The second phase is a survey (the second publication), which was conducted to assess the prevalence of UI in pregnant and postpartum women in Nanjing City in China. Potential barriers to attending the group-based PFMT programme and women’s willingness to participate in a supervised PFMT that provided additional information from the local people were also assessed. The third phase is to co-design the group-based PFMT programme with stakeholders and to test the feasibility of the programme.
Semi-structured reviews were conducted following the feasibility study to explore the acceptability of the programme.
Results: The findings from the systematic review showed that it was effective to undertake group-based PFMT in pregnancy to prevent UI during pregnancy and the postnatal period. However, the quality of the evidence is weak. The cross-sectional study showed UI affected 37.8% of pregnant women and 16.41% of postpartum women in Nanjing City in China. The local pregnant and postnatal women suggested that time constraints were the main barrier to participating in a group-based PFMT programme.
The results from the systematic review and the survey were discussed with the stakeholders to inform the co-design process of the group-based PFMT programme.
The programme (comprising four antenatal sessions in groups of eight with social media peer support) employed several strategies to improve women’s adherence to the programme. Then a randomized controlled feasibility study was conducted. The study included 48 pregnant women with a recruitment rate of 52.17%. The intervention was positively valued, in particular the supports promoting participants’ adherence, but additional changes need to be made to the programme for a future trial.
Conclusion: Group-based PFMT programme provides a possible way of delivering PFMT with limited health professionals in China. The study showed promising results concerning the acceptability and feasibility of the intervention, which were well perceived by both pregnant women and the midwife.
| Date of Award | 1 Jun 2024 |
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| Original language | English |
| Awarding Institution |
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| Supervisor | Susan Woodward (Supervisor), Lynn Sayer (Supervisor) & Sam Bassett (Supervisor) |