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

项目摘要 自我护理预防不同类型产妇分娩相关性UI 尽管有令人信服的证据表明，骨盆底肌肉训练（PFMT）可以降低育龄妇女的风险， 尿失禁（UI）高达39-59% 1;2;3，很少有育龄妇女采用和维持这种做法。 最近的审查重申PFMT是妊娠/产后的推荐做法4，但只有20-52%的 育龄妇女报告其使用情况5;3;6。此外，几乎所有以前的自我护理试验，以防止UI 和白人女人在一起我们对老年女性进行的随机对照试验测试了联合使用 PFMT和膀胱训练（BT）自我管理计划应用班杜拉的7个自我效能理论： 在强化班教授干预措施，并显示出双重预防效果8。此外，委员会认为， 对PFMT的依从性很高（在指导后3个月时为82%），并且持续（在12个月时为68%）。这些 结果鼓励我们扩展我们当前的研究（NIH R 01 NR 07618，PI C. Sampselle）与此竞争 延续。为了确保足够的种族/民族代表性，我们将对非裔美国人和 西班牙裔妇女使用以社区为基础的网站，为不同的病人。目标1将确定 一个密集的产前膀胱健康课程，以防止UI在产后12个月的不同样本， 非裔美国人、高加索人和西班牙裔育龄妇女。目标2将审查 坚持调解自我效能与UI发病率的关联。目标3将探讨态度和 促进或阻止遵守的3个种族/族裔群体之间的战略。目的4将探讨 首次分娩后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 RCT遵循考虑人种/种族的意向治疗假设。为了实现目标2，我们将 评估坚持作为自我效能和UI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 患者目标2和3的结果将提供见解，重新：中介作用的坚持和关于 自我管理的促进者/障碍。目标4的结果将产生急需的长期数据， 这些UI预防性自我护理实践的潜在益处。最终，我们打算提高效率， 随机对照试验（RCT），将根据此处提出的研究结果进行通知。项目叙述 自我护理预防分娩相关性尿失禁 骨盆底肌肉训练（凯格尔运动）减少尿失禁， 强烈推荐给孕妇和产后妇女，但很少有人这样做。这 这项研究将测试一种自我护理的组合，包括骨盆底肌肉训练， 怀孕第一、第二或第三个孩子的多文化妇女群体。在 早期的一项研究表明，这种自我护理的结合使女性失禁的风险降低了一半， 一年后。如果成功，一个重要的新方法，以防止尿失禁将是 为产妇提供。

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.