Barriers to Adherence to Remote Pelvic Floor Muscle Training Among Postpartum Women: A Qualitative Study Guided by the COM-B Model.

BACKGROUND: Pelvic floor muscle training (PFMT) is recognized as the first-line conservative intervention for postpartum pelvic floor rehabilitation. Remote pelvic floor muscle training, defined as a training modality conducted at home via mobile applications, online platforms, teleconsultation, or application-based reminders, without real-time on-site supervision, has expanded the accessibility of rehabilitation services; however, patient adherence remains suboptimal. Elucidating the barriers to adherence is critical for developing effective and well-accepted intervention strategies. This study, grounded in the Capability, Opportunity, Motivation-Behavior (COM-B) model, investigated various barriers to adherence among postpartum women engaged in remote pelvic floor muscle training.

METHODS: A qualitative descriptive study was conducted at a pelvic floor rehabilitation clinic in Wuxi, China, between November and December 2025. Fifteen postpartum women aged 27-36 years (6 weeks to 6 months postpartum) participated. The sample included primiparous and multiparous women, both vaginal and cesarean deliveries, and mixed symptomatic and asymptomatic participants. All had prior experience with at least one remote PFMT modality within the preceding six months. Semi-structured interviews were analyzed using directed content analysis guided by the COM-B model. Thematic saturation was reached after 12 interviews and confirmed with 3 additional interviews. Analytical rigor was ensured through independent double-coding of all transcripts, inductive code allowance, audit trail, and member checking.

RESULTS: Eleven barriers were identified across the three COM‑B domains. Capability barriers comprised knowledge deficits, skill deficits, and physical discomfort. Opportunity barriers comprised caregiving burden, limited professional support, inadequate family support, and technological constraints. Motivation barriers comprised low perceived urgency, lack of perceived benefits, low self‑efficacy, and habit formation difficulties. Barriers did not operate in isolation: inadequate knowledge reduced perceived urgency, limited professional feedback amplified skill uncertainty and lowered self‑efficacy, caregiving burden simultaneously restricted opportunity and depleted physical and cognitive resources, and technological friction converted convenience into a motivational cost.

CONCLUSION: Postpartum women face multiple, interrelated barriers to remote PFMT adherence spanning all COM‑B domains. A blended care model that combines initial in‑person technique verification, low‑friction digital platforms with structured cues and progress tracking, periodic professional tele‑follow‑up, and family engagement components may more effectively address these barriers than standalone self‑guided remote delivery. These findings provide theory‑based, actionable guidance for designing hybrid postpartum rehabilitation services.