Women’s motivation to perform pelvic floor muscle training for prevention of pelvic organ prolapse

Pelvic organ prolapse;Prevention;Health promotion;Pelvic floor muscle training;Women;;s health;Nursing;Case study methodology

Macfarlane, Emma Rose ; Hay-Smith, Jean ; Halksworth-Smith, Gillian

University of Otago

关键词: Pelvic organ prolapse;    Prevention;    Health promotion;    Pelvic floor muscle trainingWomen;    ;    s health;    Nursing;    Case study methodology;   

Others  :  https://ourarchive.otago.ac.nz/bitstream/10523/5773/1/MacfarlaneEmmaR2015MHealSc.pdf

美国|英语

来源: Otago University Research Archive

【 摘 要 】

Pelvic organ prolapse (POP) is associated with decreased physical, psychological, and sexual health. Pelvic floor muscle training (PFMT) is an effective treatment for POP and other pelvic floor dysfunctions (such as urinary incontinence) and there is some evidence PFMT may help prevent POP. However, poor exercise adherence is a major barrier to PFMT effectiveness. Investigating women’s motivation for PFMT to prevent POP may elicit useful insights into how clinicians can assist women to effectively incorporate into PFMT into their lives.Using case study methodology, and a theoretical proposition based on Pender’s Health Promotion Model, the influences on women’s motivation to start and continue (or not) PFMT for prevention of POP was explored. The theoretical proposition was that; there are internal and external influences that affect women’s choices about performing PFMT, and it is the way that these influences are motivating or not that affect their choice. Influences may not be the same for every woman and nor is the degree to which they may, or may not, act as a motivator. Case one was comprised of two women (both previous participants in a trial of PFMT for prevention of POP) and the physiotherapist who provided treatment. Case two was a Family Planning client and the female doctor who, during the course of clinical assessment, identified the woman had asymptomatic POP. Transcripts from the semi-structured interviews were analysed according to the principles of case study methodology. Analysis began with explanation building within each case; data were coded for meaning and then categorised (deductively) according to the main concepts in Pender’s HPM. Inductive categories were derived for data that did not map to the model and rival theoretical explanations (Bandura’s Social Cognitive Theory, Ajzen’s Theory of Planned Behaviour and Protection Motivation Theory) for these data were considered. Cross case analysis compared the two cases relative to the theoretical proposition. Three key influences on motivation were identified; (1) The woman’s socio-cultural context, (2) PFMT self-efficacy, (3) Health promotion delivery. The first described how a woman’s attitudes, beliefs, knowledge and choices about PFMT are situated within her socio-cultural context that include influences such as taboos about discussing genital health, beliefs about health priorities, and spousal/family relationships. For the second, knowledge and skills were an important starting point yet personal agency and expectancy outcomes are necessary to initiate and maintain PFMT as a health promoting behaviour. The third influence captured the clinicians’ role in providing a context that enables sharing of sensitive information and supporting women to achieve self-efficacy. The ;;incidental’ finding of POP in the Family Planning environment was associated with particular difficulties for supporting the client to achieve PFMT self-efficacy and thus the effectiveness of the health promoting moment was compromised. Public health education to increase awareness of POP and provide women with PFMT skills is needed to enable them to adopt PFMT as a health promoting behaviour. Clinicians working in primary care, particularly in women’s health contexts such as Family Planning, potentially have a major role to play in implementing such initiatives.