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

描述（由申请人提供）：尽管有令人信服的证据表明盆底肌肉训练（PFMT）可降低育龄妇女尿失禁（UI）的风险高达39% -59% 1;2；很少育龄妇女采用并维持这种做法。最近的综述重申PFMT是妊娠/产后推荐的做法4，但只有20-52%的育龄妇女报告使用它5;3;6。此外，几乎所有之前的自我护理预防尿失禁的试验都是针对白人女性的。我们对老年妇女的随机对照试验测试了PFMT和膀胱训练（BT）自我管理项目联合预防尿失禁的效果，应用了Bandura的自我效能理论：干预是在一个强化课程中进行的，并证明了双重预防效果。此外，PFMT的依从性很高（指导后3个月时为82%）并持续（12个月时为68%）9。这些结果鼓励我们以这种竞争性的延续来扩展我们目前的研究（NIH R01 NR07618, PI C. Sampselle）。为了确保充分的种族/民族代表性，我们将使用社区为不同患者服务的网站对非裔美国人和西班牙裔妇女进行抽样。目的1将确定在非裔美国人、白种人和西班牙裔育龄妇女的不同样本中，强化产前膀胱健康班预防产后12个月尿不清的疗效。目的2将检验依从性在自我效能感与尿失尿发生率之间的中介作用。目标3将探讨三个种族/民族群体促进或阻碍依从性的态度和策略。目的4将探讨膀胱健康班在指数出生后3年的疗效。为了实现目标1和目标4，我们将在考虑种族/民族的意向治疗假设下进行单盲随机对照试验。为了完成目标2，我们将评估依从性作为自我效能感和UI之间关系的中介的作用。如果Aim 1的假设得到支持，强化膀胱健康课程可能成为产科患者的标准护理。目标2和目标3的结果将提供关于依从性的中介作用和自我管理的促进者/障碍的见解。目标4的结果将产生非常需要的长期数据，关于这些尿失联预防性自我保健实践的潜在好处。最终，我们打算进行有效的随机对照试验，这将由这里提出的研究结果提供信息。

DESCRIPTION (provided by applicant): 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 effectiveness RCT, which will be informed by the results of the study proposed here. 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.