To experimentally examine whether self-efficacy and social support promotion can enable women in low resource settings to promote their pelvic floor related behavior and health compared to giving information only. And, whether self-efficacy and social support promotion for protective carrying behaviors can improve women's pelvic floor health.
In a 3-arm parallel non-randomized controlled trial including 300 women and their social partners three villages of rural Nepal received 1) self-efficacy, 2) self-efficacy + social support or 3) information only control.
All participants in all groups received information about possible health consequences of heavy lifting, pelvic-floor-protective carrying and pelvic floor disorder prevention by coping with high intra-abdominal pressure while lifting, weight limit recommendations and, instruction of co-contraction of the PFM and, instruction (no practice) of pelvic-floor-protective lifting.
Thereafter, self-efficacy group participants attended activities that aimed to increase their self-efficacy based on psychological theory and practiced pelvic-floor-protective lifting. Self-efficacy + social support group participants additionally had a social partner, who received all intervention measures together with her.
Health care practitioners were comprehensively educated by psychologists and public health experts on self-efficacy and social support promotion, and by a pelvic physiotherapist as pelvic-floor-protective lifting techniques’ instructor.
Co-primary outcomes were carried weight reduction and use of pelvic-floor-protective lifting techniques at two-month follow-up. Secondary outcomes addressed pelvic floor health (measured by: Revised Faces pain and numerical pain rating scale for pelvic/urogenital pain, Pelvic Organ Prolapse Symptom Score, International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form, Pelvic Floor Impact Questionnaire).
Sample size was estimated at N=300 by an a priori power analysis for a repeated-measures analysis of covariance for three groups (power: >80%, α=0.05). Intervention effects were calculated by repeated measures analyses of covariance and planned contrasts.
Self-efficacy promotion increased the use of pelvic-floor-protective lifting techniques compared to information only control (p=0.013, d=0.28). When additionally promoting social support, weight was reduced by 3kg more compared to self-efficacy alone (p=0,005, d=0.39). Women in all groups showed decreased symptoms of pelvic organ disorders (p0.001, η²=0.10).
As all groups showed a decrease in pelvic organ disorders’ symptoms this approach seems promising and feasible in a low-resource setting and should be further investigated including a control group and with stand-alone interventions, as this trial addressed pelvic-floor-protective lifting together with carried weight reduction.
This trial provides first promising evidence that self-efficacy and social support promotion enable women to improve care for their pelvic floor health in rural Nepal and therefore may complement educational approaches, including recommendations to reduce weight carried and physiotherapeutic instructions of pelvic-floor-protective lifting techniques.
Pelvic Organ Prolapse
Physiotherapy
