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Shared decision-making ability among women with postpartum urinary incontinence: A mixed-methods study to inform
Jie Li1, Yingying Zhang2, Wenjun Tang3
1Department of Nursing, Shenzhen Hospital, Southern Medical University, Shenzhen 518101, China; School of Nursing, Southern Medical University, Guangzhou, 510515, China.
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.
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