Proactive pelvic floor health behaviors during pregnancy: A qualitative study based on the integrated theory of health behavior change
This qualitative study, grounded in the Integrated Theory of Health Behavior Change, reveals that pregnant women's proactive engagement in pelvic floor health is shaped by dynamic interactions of fragmented knowledge, self-regulatory challenges, and unstable social support, suggesting a need for personalized, empowerment-oriented interventions that integrate credible digital tools and cultural sensitivity.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
Every woman's body carries a hidden network of muscles at the base of the pelvis, acting like a supportive hammock for the bladder, uterus, and bowel. When these muscles weaken, often due to the strain of pregnancy and childbirth, they can lead to troubling issues like involuntary leakage of urine or a feeling of heaviness in the lower body. While these problems are common, many women do not realize they can take steps to strengthen these muscles before a baby is even born. The idea of "proactive" health is simple: instead of waiting for a problem to appear and then fixing it, a person takes action beforehand to prevent the trouble entirely. However, knowing that one should exercise these muscles is very different from actually doing it every day. Understanding why some women start these exercises and stick with them, while others do not, requires looking beyond simple instructions and into the complex mix of what people know, how they manage their daily lives, and the support they receive from others.
Researchers at Southern Medical University Shenzhen Hospital set out to understand this gap between knowing and doing. They spoke with twenty-one pregnant women in Shenzhen, China, asking them about their thoughts, habits, and experiences regarding pelvic floor health. The team used a framework called the Integrated Theory of Health Behavior Change, which suggests that any lasting change in behavior depends on three things working together: what a person knows and believes, their ability to plan and monitor their own actions, and the help they get from friends, family, and doctors. By listening closely to the women's stories, the researchers found that the path to exercising these muscles is rarely a straight line. It is a winding journey shaped by fragmented information, the struggle to fit new habits into a busy life, and the varying quality of support available from the outside world.
The first major hurdle the women faced was a lack of clear, complete knowledge. While every single participant had heard of the concept of pelvic floor health, most did not understand how the muscles worked or how to exercise them correctly. Many believed these exercises were only necessary after the baby was born, or they knew the term "Kegel exercises" but felt too unsure to try them on their own. One woman explained that she knew it was important, but neither her doctor nor her family had shown her how to do it properly. This uncertainty created a barrier to starting. Even among the few women who did exercise regularly, many were doing so for other reasons, such as controlling their weight or managing blood sugar, rather than a specific focus on pelvic health. They were essentially benefiting their pelvic floor by accident, without realizing it. For most, the urgency to act only arrived when they felt symptoms or after the delivery, rather than during the pregnancy itself.
Even when a woman wanted to start, keeping the habit going proved difficult without a solid plan. The study found that most participants did not have a clear schedule for their exercises. Life got in the way; work, childcare, and physical fatigue from pregnancy often interrupted their routines. Without a set time or a specific goal, the exercises became something to do "when I remember," which rarely happened consistently. Some women felt physically too weak or worried that exercising might harm their baby, especially if they had heard stories of others experiencing bleeding. Only a small portion of the women, about thirty-eight percent, managed to maintain a regular exercise routine throughout their pregnancy. For those who did, the key was often a pre-existing habit of exercise before they became pregnant, or a very clear vision of wanting to recover their physical strength quickly after giving birth.
The environment surrounding these women played a massive role in whether they succeeded or gave up. They received information from many sources: doctors, family members, friends, and especially digital platforms like short-video apps and social media. While nearly all the women used these online tools to find guidance, they often found the information confusing or unreliable. One participant noted that the videos were inconsistent, making it hard to tell what was true. Family members, while well-meaning, often did not understand the specific needs of pelvic floor health. Professional medical advice was sometimes limited to a single suggestion or was difficult to access due to cost or travel time. The result was a situation where women were flooded with information but lacked a trusted, steady guide to help them navigate it. The support they received was often present but unstable, changing depending on the day or the specific person they spoke to.
Despite these challenges, the researchers identified a few powerful drivers that helped women stay on track. When a woman felt immediate positive feedback, such as a sense of relaxation or an improvement in her mood after exercising, she was more likely to continue. However, this positive feeling had to be strong enough to overcome the daily obstacles of fatigue and time. The study suggests that for health behaviors to stick, they cannot rely on a single factor. A woman needs to understand the "why," have a realistic plan for the "how," and receive consistent, trustworthy support from her community and healthcare providers. The findings indicate that simply telling women to exercise is not enough. To truly help, health programs need to move beyond just giving information. They must help women build confidence, create simple plans that fit into their real lives, and connect them with reliable resources that can guide them step-by-step. By addressing the mental, practical, and social sides of the problem together, it becomes possible to turn the intention of staying healthy into a lasting reality.
Drowning in papers in your field?
Get daily digests of the most novel papers matching your research keywords — with technical summaries, in your language.