Midwifery · 2025
Shared decision-making ability among women with postpartum urinary incontinence: A mixed-methods study to inform midwifery practice.
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Li Jie, Zhang Yingying, Tang Wenjun, Huang Shurong, Li Quanlei, Cai Wenzhi
Аннотация
PROBLEM: Pelvic floor physical therapy (PFPT) is the first-line treatment for postpartum urinary incontinence (PPUI), but barriers such as limited access and low engagement in decision-making reduce adherence.
BACKGROUND: Shared decision-making empowers women to participate in care and improve adherence. Variations in shared decision-making ability may limit engagement.
AIM: To measure shared decision-making ability regarding PFPT and identify its influencing factors among women with PPUI through a quantitative phase, and derive midwifery support strategies based on qualitative insights.
METHODS: This mixed-methods study collected quantitative and qualitative data to explore shared decision-making among women with PPUI using the Capability, Opportunity, Motivation-Behavior model. Surveys on illness perception, e-health literacy, social support, decision self-efficacy, and shared decision-making ability were completed by 528 participants. Structural equation modeling and bootstrapped mediation analyses were performed. Fourteen participants were then interviewed about their PFPT decision-making experiences.
FINDINGS: Participants had moderate shared decision-making ability. Illness perception, e-health literacy, social support, and decision self-efficacy were positively associated with shared decision-making ability. Decision self-efficacy partially mediated these relationships: illness perception, e-health literacy, and perceived social support. Qualitative findings revealed diverse decision-making models, from shared to midwife-led approaches, and suggested strategies to enhance shared decision-making.
DISCUSSION: Shared decision-making ability is associated with interrelated psychosocial and behavioral factors. Enhancing illness perception, e-health literacy, social support, and decision self-efficacy may be related to greater engagement of women in PFPT decisions.
CONCLUSION: Midwives can foster shared decision-making through tailored education, resource facilitation, family engagement, and confidence-building, potentially improving PFPT participation and outcomes.
BACKGROUND: Shared decision-making empowers women to participate in care and improve adherence. Variations in shared decision-making ability may limit engagement.
AIM: To measure shared decision-making ability regarding PFPT and identify its influencing factors among women with PPUI through a quantitative phase, and derive midwifery support strategies based on qualitative insights.
METHODS: This mixed-methods study collected quantitative and qualitative data to explore shared decision-making among women with PPUI using the Capability, Opportunity, Motivation-Behavior model. Surveys on illness perception, e-health literacy, social support, decision self-efficacy, and shared decision-making ability were completed by 528 participants. Structural equation modeling and bootstrapped mediation analyses were performed. Fourteen participants were then interviewed about their PFPT decision-making experiences.
FINDINGS: Participants had moderate shared decision-making ability. Illness perception, e-health literacy, social support, and decision self-efficacy were positively associated with shared decision-making ability. Decision self-efficacy partially mediated these relationships: illness perception, e-health literacy, and perceived social support. Qualitative findings revealed diverse decision-making models, from shared to midwife-led approaches, and suggested strategies to enhance shared decision-making.
DISCUSSION: Shared decision-making ability is associated with interrelated psychosocial and behavioral factors. Enhancing illness perception, e-health literacy, social support, and decision self-efficacy may be related to greater engagement of women in PFPT decisions.
CONCLUSION: Midwives can foster shared decision-making through tailored education, resource facilitation, family engagement, and confidence-building, potentially improving PFPT participation and outcomes.