title: Pelvic-floor-muscle-training adherence "modifiers": A review of primary qualitative studies-2011 ICS State-of-the-Science Seminar research paper III of IV.
abstract: OBJECTIVE
  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.
authors.affiliation: Rehabilitation Teaching and Research Unit, University of Otago, Wellington, New Zealand.|Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago, New Zealand.
authors.forename: Jean
authors.initials: J
authors.lastname: Hay-Smith
authors.affiliation: Institute of Health Research, University of Exeter Medical School, Exeter, United Kingdom.
authors.forename: Sarah
authors.initials: S
authors.lastname: Dean
authors.affiliation: Division of Gerontology, Geriatrics and Palliative Care, University of Alabama at Birmingham, Birmingham.|Birmingham/Atlanta Geriatric Research, Education and Clinical Center, Department of Veterans Affairs, Birmingham.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Burgio
authors.affiliation: Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, Scotland.
authors.forename: Doreen
authors.initials: D
authors.lastname: McClurg
authors.affiliation: Allied Health, La Trobe University, Melbourne, Australia.|Allied Health, Cabrini Health, Melbourne, Australia.
authors.forename: Helena
authors.initials: H
authors.lastname: Frawley
authors.affiliation: School of Rehabilitation, Faculty of Medicine, University of Montreal, Montreal, Canada.|Urogynaecological Health and Aging, Research Centre of the Institut Universitaire de Geriatrie de Montreal, Montreal, Canada.
authors.forename: Chantale
authors.initials: C
authors.lastname: Dumoulin
mesh_terms: D019317:Evidence-Based Medicine; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D009042:Motivation; D010349:Patient Compliance; D010353:Patient Education as Topic; D017773:Pelvic Floor / Q000503:physiopathology*; D016896:Treatment Outcome; D014549:Urinary Incontinence / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*
keywords: adherence; pelvic floor muscle training; qualitative research; review