Self-Care to Prevent Birth-Related UI in Diverse Women

项目摘要 自我护理预防不同性别女性生育相关尿失禁 尽管有令人信服的证据表明，盆底肌肉训练(PFMT)可以降低育龄妇女患 尿失禁(UI)减少高达39-59%1；2；3，采用并维持这一做法的育龄妇女太少。 最近的审查重申，PFMT是怀孕/产后的推荐做法4，但只有20%-52%的 5；3；6。此外，几乎所有以前预防尿失禁的自我护理试验都有 和高加索女人在一起。我们对老年妇女进行的随机对照试验，测试了联合应用 PFMT和膀胱训练(BT)自我管理计划应用了班杜拉的7种自我效能理论： 在强化课上教授干预措施，并展示了双重预防效果8。 对全氟化碳治疗的依从性很高(在指导后3个月为82%)，并持续(在12个月时为68%)9. 结果鼓励我们扩展我们目前的研究(NIH R01 NR07618，Pi C.Sampselle)与此竞争 继续。为了确保充分的种族/民族代表性，我们将对非洲裔美国人和 拉美裔妇女使用基于社区的网站，为不同的患者提供服务。目标1将确定 一项预防产后12个月尿失禁的强化产前膀胱健康课 非裔美国人、高加索人和西班牙裔生育妇女。目标2将考察 坚持在自我效能感与尿失禁发生率之间起中介作用。目标3将探索态度和 促进或阻止遵守的3个种族/民族群体之间的战略。目标4将探索 出生后3年的膀胱健康等级。为了实现目标1和4，我们将进行单盲法 在考虑到种族/族裔的情况下，遵循意向治疗假设进行随机对照试验。为了实现目标2，我们将 评估坚持性在自我效能感和UI之间的关系中的中介作用。如果目标为1 假设得到支持，强化膀胱健康课程可能成为产妇护理的标准 病人。目标2和3的结果将提供洞察力Re：坚持和关于 自我管理的促进者/障碍。AIM 4的结果将产生关于 这些尿失禁预防性自我护理实践的潜在好处。最终，我们打算建立一个有效的 RCT，它将从这里建议的研究结果中了解情况。项目叙事 自我护理预防产后性尿失禁 盆底肌肉训练(Kegel运动)可减少尿失禁 强烈推荐给孕妇和产后妇女，但很少有人会这样做。这 研究将测试包括盆底肌肉训练在内的自我护理组合 怀有第一个、第二个或第三个孩子的妇女的多元文化群体。在……里面 早些时候的一项研究表明，这种自我护理相结合的方式可以将女性大小便失禁的风险降低一半 一年后。如果成功，预防尿失禁的一个重要新方法将是 可供产妇使用。

Project Abstract SELF-CARE TO PREVENT BIRTH-RELATED UI IN DIVERSE WOMEN Despite compelling evidence that pelvic floor muscle training (PFMT) reduces childbearing women's risk of urinary incontinence (UI) by up to 39-59% 1;2;3, too few childbearing women adopt and sustain this practice. Recent review reaffirms PFMT as recommended practice during pregnancy/postpartum 4, but only 20-52% of childbearing women report its use 5;3;6. Moreover, virtually all previous trials of self-care to prevent UI have been with Caucasian women. Our RCT with older women testing the UI prevention efficacy of a combined PFMT and bladder training (BT) self-management program applied Bandura's 7 self-efficacy theory: the intervention was taught in an intensive class and demonstrated a two-fold preventive effect 8. Furthermore, adherence to PFMT was high (82% at 3 months post instruction) and sustained (68% at 12 months) 9. These results encourage us to extend our current study (NIH R01 NR07618, PI C. Sampselle) with this competing continuation. To assure adequate racial/ethnic representation, we will over sample African American and Hispanic women using community-based sites that serve diverse patients. Aim 1 will determine the efficacy of an intensive antenatal Bladder Health Class to prevent UI at 12 months postpartum in a diverse sample of African American, Caucasian, and Hispanic childbearing women. Aim 2 will examine the capacity of adherence to mediate the association of self-efficacy with UI incidence. Aim 3 will explore the attitudes and strategies among 3 racial/ethnic groups that facilitate or deter adherence. Aim 4 will explore the efficacy of the Bladder Health class at 3 years post index birth. To accomplish Aims 1 and 4, we will conduct a single-blind RCT following intention-to-treat assumptions taking race/ethnicity into account. To accomplish Aim 2, we will assess the role of adherence as a mediator of the relationship between self-efficacy and UI. If Aim 1 hypotheses are supported, an intensive Bladder Health Class could become the standard of care for maternity patients. Aim 2 & 3 results will provide insights re: the mediating role of adherence and about facilitators/barriers to self-management. Aim 4 results will yield much needed long term data regarding the potential benefit of these UI preventive self-care practices. Ultimately we intend to mount an effectiveness RCT, which will be informed by the results of the study proposed here. Project Narrative SELF-CARE TO PREVENT BIRTH-RELATED URINARY INCONTINENCE Pelvic floor muscle training (Kegel Exercise) reduces urinary incontinence and is strongly recommended for pregnant and postpartum women, but very few do them. This study will test a combination of self-care that includes pelvic floor muscle training in a multicultural group of women who are pregnant with their first, second, or third child. In an earlier study this combination of self-care cut women's risk of incontinence in half one year later. If successful, an important new way to prevent urinary incontinence will be available for maternity patients.