Table 4 Summary of barriers and enablers to performing pelvic floor rehabilitation behaviours mapped to the Theoretical Domains Framework domains
Theme | Sub-theme | Barrier/enabler | TDF domain | The representative interview quotation |
|---|---|---|---|---|
Individual knowledge and experience of pelvic floor management | Knowledge of urinary incontinence | Enabler | Knowledge | So, is it mainly because my ability to control my pelvic floor muscles is weak? Control of that piece of muscle, right? The reason for pelvic floor muscle exercises is that the pelvic floor muscles are flabby and cannot provide adequate support. For example, the two muscles in the isthmus may be relatively flabby, and some pelvic structures may not be supported adequately. Muscle… are the muscle fibres not good? Right? [P05] |
Incorrect or very limited knowledge on pelvic floor management | Barrier | Knowledge | I do not know the classification of urinary incontinence. I have not experienced urinary incontinence. I only experienced urine leakage when I had a cough or cold. [P11] I have not paid much attention to lifestyle. I really do not understand the diet, and I do not understand what effect it will have on the pelvic floor muscles or this kind of anti-urinary incontinence. [P03] | |
Good skills in pelvic floor management | Enabler | Skills | Kegel training… tightening (pelvic floor muscles), tightening, and releasing. [P11] | |
Lack of skills in pelvic floor management | Barrier | Skills | I preferably need a training course or some kind of guidance. I am afraid of doing it the wrong way. [P04] I definitely need training to raise my awareness of pelvic floor management. I know only little about this. There are courses in Hospital A, are there not? However, although I have learned a little, I feel it is superficial and not very deep. [P09] | |
Have the confidence to control the disease | Enabler | Beliefs about capabilities | Where are those muscles? I know. He taught me (referring to the coach). Is it Kegel? I know it so well that I can help you in writing this paper, ha-ha. [P06] | |
Uncertainty about one's own abilities | Barrier | Beliefs about capabilities | It is easy to do this (pelvic floor management), but I may not be able to adhere to it. This is mainly a matter of persistence. It is just like we do with weight loss exercise: think of it and then jump the rope twice. However, it is difficult to adhere to. [P12] I do not know if I can stick to pelvic floor management. Like losing weight, one should just be willing to exercise for a period of time. Pelvic floor management it is good, is it not, ah? Eating less and sleeping more is also good; it is the same thing; you cannot all be sticking to it and have a good habit every day. [P05] | |
Judgments about expected outcomes | Perceived benefits of pelvic floor management and the consequences of non-adherence | Enabler | Beliefs about consequences | It is better to exercise than not to exercise, and you are definitely better off tighter than flabby. I think during my pregnancy I might have leaked a bit, as we all do. If I do not exercise after giving birth or if I have this kind of frequent urination or urinary incontinence, it is not a good feeling. It is different from other people, and it is abnormal. Thus, it would be better to return to a relatively normal level. [P18] There are some negative consequences of urinary incontinence, such as muscle relaxation and urine leakage, when you get older, which can have an impact on your life. If you do not manage it well, you are going to feel like you are causing a lot of trouble. Each time you sneeze, you would have to change your underwear or would need protective pads or something, and you have to find a place for such sanitary purposes. Do you have to take a bunch of things with you when you go out? [P10] I do not sit, stand, or lie down for long periods of time because it causes constipation and tailbone pain, so I subconsciously walk a little after sitting for a long time. [P18] |
Doubts about the value of pelvic floor management | Barrier | Beliefs about consequences | I know that recovery varies from person to person. Some people have actually done so and may not have recovered very well. [P12] | |
Interactions of interpersonal situations | Positive impacts on socio-cultural | Enabler | Social influences | (Kegel training) post-95Â s all know I think. [P06] |
Negative influences of socio-cultural | Barrier | Social influences | I asked people around me about my urine leakage, and I have also asked those who have given birth to children around me. They said it was normal, and they said that you could repair it after you have given birth, and they all answered in this way. I can say that this is completely blank because I have also come to this conclusion from living examples around me. When my friends around me gave birth to their children, none of them had this awareness. In other words, the awareness of pelvic floor management during pregnancy should be relatively blank. [P17] | |
Accessibility to social support | Enabler | Social influences | (1) Information and advice provided by the medical team Unless you are seeing a doctor whose guidance is important. [P05] (2) Support from family members I do not know if my family and husband will support me because they cannot feel the pain. First, if this is not particularly serious, it may not have a great impact on my life, making it even more impossible for them to understand my confusion. If there is help and reminders from family members, it may be very good. If my family feels that it does not matter because they cannot understand me either, I think would be a bit difficult to stick with this if I am completely on my own. [P14] (3) Peer support Like in any other sport, if you feel like you are the only person participating in this activity and you have no partner, you might feel confident at the beginning, but after a while, you might start to feel tired, frustrated, or for a variety of other reasons, you may give up slowly. If there was a group of friends at that time, they might say, for example, "Eh, did you exercise today" or something like that. There may be mutual supervision. [P14] (4) Network support from local communities and other groups Some of my colleagues had babies, and after their second child, they said that the leakage was more severe. In fact, this unit or one of your commonweal organizations may promote this Kegel exercise for pelvic floor muscle rehabilitation. I can the integrate into a certain exercise group or a yoga group, and then you may combine this kind of commonweal promotion with this kind of union of a certain unit so we can all form an atmosphere where we can exercise together, right? It is a very good thing to spend time exercising collectively during working hours. Nowadays, many trade unions also organise activities, but not specifically for the pelvic floor. I think it would be ideal if you were to promote it from an advocacy point of view, that is, an initiative, and then let us cooperate. [P07] | |
Environment, resources, and decision-making processes | Objective constraints lead to forgetfulness | Barrier | Memory, attention and decision processes | When I am busy at work, something like raising a baby, or something else, will distract me and I will not think about it at all. [P10] There will be instances when I forget to exercise. If I choose to exercise every day of the week, I may miss two or three days. [P06] It is truly necessary to focus on this aspect of pelvic floor management and provide time away from home for exercise. I am not free when I get home. Do you understand? [P07] An alarm clock will help remind me of my own pelvic floor management. [P20] |
The high accessibility of information | Enabler | Environmental context and resources | Online resources are available. During this time, you might find this kind of information on Tiktok or whatever. Xiaohongshu also contains this information. [P04] | |
Variable quality of information | Barrier | Environmental context and resources | There are several information on the internet. Some of these information may be good knowledge, while others may be incorrect. [P14] | |
Limited comprehensibility of information | Barrier | Environmental context and resources | I prefer to obtain information that is simple and straightforward, that can be understood at once. I might not be able to understand it if it is boring and tedious. [P02] | |
Personal goal-setting and efforts towards behaviour change | Perceived poor physical condition increases individual willingness to manage | Enabler | Intentions | The possibility of sticking to pelvic floor management for me was 100%. I definitely want to improve myself. I am sure I will stick to it. If I know I have a problem or something, I am sure I will be able to change it and achieve the best possible state. [P04] |
Perceived good physical condition weakens individual management intention | Barrier | Intentions | As before, after I gave birth to my first child, I found out that I had incontinence, so I might have looked online to find out why it was happening. However, because it did not have a big impact on my life, I did not say I had to perform pelvic floor management to improve it (laughs). [P14] | |
Low priority | Barrier | Goals | I think brushing your teeth is necessary every day, but if you do not brush your teeth, for example, you will have tooth decay, and there will be many subsequent problems later. I feel that (pelvic floor management) may not be as important. [P19] | |
Self-responsibility | Enabler | Social / professional role and identity | I will manage this myself. Because you have this problem, you must solve it. I do not want to have an unpleasant disease because I am a traditional Chinese medicine practitioner myself, and I want to be healthy because there are some things—the same as traditional Chinese medicine, I will give you the best technology and best therapies. If you do not exercise or self-manage, it will not work. I think this thing is still on your own. [P15] | |
Behaviour change strategies | Enabler | Behavioural regulation | I would probably perform pelvic floor muscle exercises before going to bed or at a fixed time anyway. As such, I think it may not have to be a special method, and it may be possible to practice while lying on the bed. Maybe I could perform the exercises before going to bed. [P05] | |
Self-motivation | Enabler | Reinforcement | Buy yourself a bag. [P06] | |
Emotional influences on decision-making | Safety in pelvic floor management | Enabler | Emotions | There seems to be nothing special about this treatment. This is a type of muscle exercise. I did not hear anything about side effects, so I do not have any concerns. [P03] |
The emotional burden of urinary incontinence | Barrier | Emotions | I do not exercise if I am in a bad mood. [P06] I am more annoyed and worried. If I sneeze later, will there be (leakage of urine)? [P10] | |
Personal characteristics | Positive impacts on personal characteristics | Enabler | Not applicable | Be rational about things, such as urinary incontinence, as it often occurs. This is because pregnancy is stressful, right? Suddenly, the belly gets bigger and the body has urinary incontinence. [P06] I will manage this myself. I do not like to say that I just like to do it, and then have a problem solving it. I am this kind of person. [P15] |
Negative influence of personal characteristics | Barrier | Not applicable | What gets in the way of pelvic floor management is laziness. Lazy people do not want to move. [P04] |