Effectiveness and Adherence Determinants of Digital Pelvic Floor Interventions in Pregnancy and Postpartum: A Mixed Methods Systematic Review and Meta-Analysis.

INTRODUCTION AND HYPOTHESIS: Despite increasing use of digital pelvic floor muscle training (PFMT) in the form of apps and web-based programmes, their effectiveness and adherence determinants during pregnancy and the postpartum period remain unclear. This review evaluated effectiveness for preventing and managing pelvic floor dysfunction (PFD), identified adherence determinants, and integrated findings using behaviour change theory.

METHODS

A mixed methods systematic review was conducted according to Joanna Briggs Institute convergent segregated approach. PubMed, CINAHL, and Scopus were searched from inception to March 2025; updated January 2026. Two reviewers screened studies, extracted data, and assessed methodological quality using the Mixed Methods Appraisal Tool. Primary outcome was PFD symptom severity, including incontinence, prolapse symptoms, sexual dysfunction, and perineal pain. Quantitative data were analysed using meta-analysis where possible, otherwise narrative synthesis. Qualitative data were synthesized using meta-aggregation and integrated using the capability-opportunity-motivation-behaviour model and behaviour change wheel.

RESULTS

Eighteen studies involving 4916 participants were included. Digital PFMT was associated with reduced urinary incontinence during pregnancy. Postpartum effects were mixed, with no pooled effect and substantial heterogeneity (MD -1.45, 95% CI -3.17 to 0.27). Qualitative synthesis yielded five adherence determinants: knowledge and confidence, emotional/contextual demands, healthcare communication, sociocultural influences, and programme usability. Integration indicated that variability in effectiveness likely reflects differences in capability, opportunity, and motivation rather than intervention content alone, clarifying behavioural pathways to consider in intervention development.

CONCLUSIONS

Digital PFMT may support pelvic floor outcomes during pregnancy and postpartum, but effectiveness depends on addressing capability, opportunity, and motivation. Mixed evidence underscores the need for theory-informed interventions targeting behavioural mechanisms that sustain engagement.