SELF-CARE TO PREVENT BIRTH-RELATED UI IN DIVERSE WOMEN: FOCUS GROUP

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This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Pelvic floor muscle training (PFMT) reduces childbearing women's risk of birth-related urinary incontinence (UI) by 39-59%. PFMT is recommended for UI prevention in pregnancy/postpartum but only 20-47% report its use. PFMT is a non-invasive self-care practice well-suited for childbearing women. Our randomized controlled trial (RCT) with older women tested the effectiveness for UI prevention of an intensive class presenting an array of self-care strategies - PFMT, (repetitive voluntary contraction and relaxation of pelvic floor muscles); bladder training (BT) (a program of scheduled voiding with progressive voiding intervals); and the Knack maneuver (intentional contraction of the pelvic floor to avoid UI). These self-care practices have demonstrated efficacy in UI treatment but our RCT was the first to demonstrate their combined capacity for UI prevention. Adherence to PFMT was 82% at three months and 68% one year post-class. Adherence was predicted by self-efficacy, concurrent BT, and routine approach to PFMT. We believe synergy exists across the strategies. The class with combined strategies will likely enhance childbearing women's practice of PFMT. Although the risk of UI is lower among African American (AA) and Hispanic women, their psychological distress with UI symptoms exceeds that of Caucasian women (1.26 times higher in AA women, 5.7 times higher in Hispanic women). Previous trials of PFMT to prevent UI included predominantly Caucasian women raising a health disparities concern of low rates for preventive health services among African Americans and Hispanics. Increased distress plus lack of evidence for UI self-care efficacy in women of color, warrant testing the effectiveness of an antenatal bladder health class (BH Class) in a future RCT. An earlier NIH application was well received but recommended that cultural appropriateness of the BH Class, the Leakage Index questionnaire, and recruitment/retention strategies be discussed with members of the target sample. The pilot proposed will generate that evidence through the following specific aims: Aim 1: Develop culturally appropriate ways to present the BH class to AA and Hispanic childbearing women. Aim 2: Assure that the Leakage Index questionnaire and the print materials used in the BH Class are at a 5th grade reading level, which is appropriate for our target population. Aim 3: Identify culturally appropriate recruitment and retention strategies for AA and Hispanic childbearing women in Southeast Michigan. To accomplish these aims, we will conduct focus groups with AA and Hispanic women. Results will inform a future NIH grant application.'