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)可将育龄妇女患尿失禁(UI)的风险降低高达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，在怀孕/产后4期间，PFMT是推荐的做法，但只有20%-52%的育龄妇女报告使用它5；3；6。此外，几乎所有以前预防尿失禁的自我护理试验都是在高加索妇女中进行的。我们对老年妇女进行了随机对照试验，测试了PFMT和膀胱训练(BT)自我管理计划相结合的尿失禁预防效果。我们应用了Bandura的自我效能理论：干预是在强化课堂上教授的，并展示了双重预防效果8。此外，对PFMT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。这些结果鼓励我们延长我们目前的研究(NIH R01 NR07618，PI C.Sampselle)，继续进行竞争。为了确保充分的种族/民族代表性，我们将使用服务于不同患者的社区网站，对非裔美国人和西班牙裔妇女进行更多抽样。目的1将确定在非裔美国人、高加索人和西班牙裔育龄妇女的不同样本中，强化产前膀胱健康课程预防产后12个月尿失禁的有效性。目标2将考察坚持在自我效能感与尿失禁发生率之间的关系。目标3将探讨3个种族/族裔群体之间促进或阻碍遵守的态度和战略。目的4探讨膀胱生后3年健康班的效果。为了实现目标1和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。为了实现目标2，我们将评估坚持作为自我效能感和用户界面之间关系的中介的作用。如果目标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。目标2和3的结果将提供关于以下方面的见解：坚持的中介作用以及自我管理的促进者/障碍。目标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益处的急需的长期数据。最终，我们打算建立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。 盆底肌肉训练(Kegel运动)可减少尿失禁，强烈建议孕妇和产后进行，但很少有人这样做。这项研究将在怀孕第一个、第二个或第三个孩子的多元文化女性群体中测试包括盆底肌肉训练在内的自我护理的组合。在早期的一项研究中，这种自我护理的组合将女性在一年后大小便失禁的风险降低了半年。如果成功，将为产妇提供一种预防尿失禁的重要新方法。

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.