Pelvic-floor-muscle-training adherence “modifiers”: a review of primary qualitative studies—2011 ICS state-of-the-science seminar research paper III of IV

Aims: This 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.
Methods: Primary 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. Results: Thirteen 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. Conclusions: Individuals’ 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.