Barriers and facilitators to implementing pelvic floor muscle training after radical prostatectomy in China: a qualitative study using the consolidated framework for implementation research.

PURPOSE: Urinary incontinence is the most common adverse outcome following radical prostatectomy (RP) for prostate cancer, and pelvic floor muscle training (PFMT) is among the most effective interventions. However, implementation of PFMT after RP in China remains limited. This study aimed to explore the barriers and facilitators influencing the implementation of evidence-based PFMT in this context.

METHODS

This qualitative study recruited 35 stakeholders comprising physical therapists, medical staff, and post-prostatectomy patients from a tertiary hospital in China during the period from December 2022 to March 2023. Participants were selected through purposive and convenience sampling. Semi-structured interviews were conducted using a guide based on the Consolidated Framework for Implementation Research (CFIR), refined through expert consultation and pre-interviews. Data were collected through audio-recorded, in-person interviews and analyzed using directed content analysis. NVivo software facilitated coding, and COREQ guidelines were followed. Triangulation and independent double coding ensured rigor and reliability.

RESULTS

Barriers in the innovation domain included evidence skepticism, implementation challenges, lack of standardization, and resource constraints; facilitators included strong support for PFMT and ease of implementation. In the outer setting, barriers included attitudinal resistance, resource inadequacy, coordination gaps, and financial constraints, while patient engagement served as a facilitator. Inner setting barriers included post-discharge support gaps, equipment limitations, and knowledge gaps; reform motivation was a facilitator. At the individual level, awareness gaps were a key barrier, while expert facilitation was beneficial. In the implementation process domain, follow-up challenges were noted, alongside adaptive implementation and data-informed decision-making as facilitators.

CONCLUSIONS

Targeted strategies and improved resource allocation are needed to support PFMT implementation and enhance recovery and quality of life in Chinese prostate cancer patients.