Shared decision-making ability among women with postpartum urinary incontinence: A mixed-methods study to inform midwifery practice

Abstract

<h3>Problem</h3><p>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.</p><h3>Background</h3><p>Shared decision-making empowers women to participate in care and improve adherence. Variations in shared decision-making ability may limit engagement.</p><h3>Aim</h3><p>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.</p><h3>Methods</h3><p>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.</p><h3>Findings</h3><p>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.</p><h3>Discussion</h3><p>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.</p><h3>Conclusion</h3><p>Midwives can foster shared decision-making through tailored education, resource facilitation, family engagement, and confidence-building, potentially improving PFPT participation and outcomes.</p>