title: Opportunities, challenges and concerns for the implementation and uptake of pelvic floor muscle assessment and exercises during the childbearing years: protocol for a critical interpretive synthesis.
abstract: Pregnancy and childbirth are important risk factors for urinary incontinence (UI) in women. Pelvic floor muscle exercises (PFME) are effective for prevention of UI. Guidelines for the management of UI recommend offering pelvic floor muscle training (PFMT) to women during their first pregnancy as a preventive strategy. The objective of this review is to understand the relationships between individual, professional, inter-professional and organisational opportunities, challenges and concerns that could be essential to maximise the impact of PFMT during childbearing years and to effect the required behaviour change.
  
  
  
  Following systematic searches to identify sources for inclusion, we shall use a critical interpretive synthesis (CIS) approach to produce a conceptual model, mapping the relationships between individual, professional, inter-professional and organisational factors and the implementation, acceptability and uptake of PFME education, assessment and training during the childbearing years. Purposive sampling will be used to identify potentially relevant material relating to topics or areas of interest which emerge as the review progresses. A wide range of empirical and non-empirical sources will be eligible for inclusion to encompass the breadth of relevant individual, professional, inter-professional and organisational issues relating to PFME during childbearing years. Data analysis and synthesis will identify key themes, concepts, connections and relationships between these themes. Findings will be interpreted in relation to existing frameworks of implementation, attitudes and beliefs of individuals and behaviour change. We will collate examples to illustrate relationships expressed in the conceptual model and identify potential links between the model and drivers for change.
  
  
  
  The CIS review findings and resulting conceptual model will illustrate relationships between factors that might affect the implementation, acceptability and uptake of PFME education, assessment and training during the childbearing years. The model will inform the development and evaluation of a training package to support midwives with implementation and delivery of effective PFME during the antenatal period. The review forms part of the first phase of the United Kingdom National Institute for Health Research funded 'Antenatal Preventative Pelvic floor Exercises And Localisation (APPEAL)' programme (grant number: RP-PG-0514-20002) to prevent poor health linked to pregnancy and childbirth-related UI.
  
  
  
  PROSPERO: CRD42016042792.
authors.affiliation: NIHR Collaboration for Leadership in Applied Health Research & Care South West Peninsula (PenCLAHRC), Institute of Health Research, University of Exeter Medical School, South Cloisters, St. Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK.
authors.forename: Victoria E
authors.initials: VE
authors.lastname: Salmon
authors.affiliation: University of Otago, Dunedin, New Zealand.
authors.forename: E Jean C
authors.initials: EJ
authors.lastname: Hay-Smith
authors.affiliation: NIHR Collaboration for Leadership in Applied Health Research & Care South West Peninsula (PenCLAHRC), Institute of Health Research, University of Exeter Medical School, South Cloisters, St. Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK.
authors.forename: Rachel
authors.initials: R
authors.lastname: Jarvie
authors.affiliation: NIHR Collaboration for Leadership in Applied Health Research & Care South West Peninsula (PenCLAHRC), Institute of Health Research, University of Exeter Medical School, South Cloisters, St. Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK.
authors.forename: Sarah
authors.initials: S
authors.lastname: Dean
authors.affiliation: Warwick Business School, University of Warwick, Coventry, UK.
authors.forename: Eivor
authors.initials: E
authors.lastname: Oborn
authors.affiliation: University of Birmingham, Birmingham, UK.
authors.forename: Susan E
authors.initials: SE
authors.lastname: Bayliss
authors.affiliation: King's College London, London, UK.
authors.forename: Debra
authors.initials: D
authors.lastname: Bick
authors.affiliation: University of Birmingham, Birmingham, UK.
authors.forename: Clare
authors.initials: C
authors.lastname: Davenport
authors.affiliation: University of Birmingham, Birmingham, UK.
authors.forename: Khaled M
authors.initials: KM
authors.lastname: Ismail
authors.affiliation: University of Birmingham, Birmingham, UK.
authors.forename: Christine
authors.initials: C
authors.lastname: MacArthur
authors.affiliation: NIHR Collaboration for Leadership in Applied Health Research & Care South West Peninsula (PenCLAHRC), Institute of Health Research, University of Exeter Medical School, South Cloisters, St. Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK. Mark.Pearson@exeter.ac.uk.
authors.forename: Mark
authors.identifier: 0000-0001-7628-7421
authors.initials: M
authors.lastname: Pearson
mesh_terms: D000328:Adult; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D017773:Pelvic Floor / Q000503:physiopathology*; D011247:Pregnancy; D000078202:Systematic Reviews as Topic; D016896:Treatment Outcome; D014549:Urinary Incontinence / Q000503:physiopathology* / Q000517:prevention & control*; D055815:Young Adult
keywords: Antenatal education; Critical interpretive synthesis; Implementation; Maternity services; Midwifery practice; Pelvic floor muscle exercise; Pelvic floor muscle training; Postpartum; Pregnancy; Urinary incontinence