JMIR Publications

ABSTRACT

Background:

Pelvic Floor Muscle Dysfunction (PFMD) is a public health issue with one in three women experiencing symptoms at some point in their lifetime. The gold standard of treatment for PFMD is supervised Pelvic Floor Muscle Training (PFMT), however adherence to PFMT in women is poor. Mobile apps are increasingly being used in the NHS to enable equity in the distribution of healthcare and increase accessibility to services. However it is unclear how PFMT mobile apps influence PFMT adherence in women.

Objective:

To compare the behaviour change techniques used to improve women’s adherence to PFMT in PFMT mobile apps.

Methods:

A systematic literature review was conducted. Published quantitative literature that compared the use of a PFMT mobile app to a control group were included to address the aims of the study. The electronic bibliographic databases searched included MEDLINE, CINAHL, Scopus and Web of Science alongside The Cochrane Central Register of Controlled Trials and PEDro. Studies were also identified from systematic review reference searching. Original articles written in English from 2006 onwards were included. Qualitative studies, studies that use male participants, case studies, web-based interventions and interventions that utilised vaginal probes were excluded. Narrative synthesis was conducted on eligible articles based on the aims of the study. The Downs and Black checklist was used to assess the quality and risk of bias of included studies.

Results:

Of the 114 records retrieved from the search, six articles met the eligibility and inclusion criteria. The total number of participants in the studies were 471. All PFMT mobile apps used prompts/ cues as a behaviour change technique compared to none in the usual care group. Opportunity was the core behavioural component targeted by PFMT mobile apps. Opportunity is associated with the ‘environment context and resources’ theoretical domain. There was evidence to suggest PFMT mobile apps increase PFMT adherence in women compared to usual care and that the use of prompts and cues in mobile apps may account for these differences.

Conclusions:

Digital prompts are a behaviour change technique commonly used in PFMT mobile apps that provide a promising way of improving PFMT adherence in women in the short term and further research is needed into the role of social opportunity in the maintenance of PFMT in women. Opportunity was the most targeted core behaviour in the intervention group of the included studies. The use of prompts and cues may have led to higher PFMT adherence in the intervention groups compared to usual care, however these apps may be best used alongside usual clinical practice with appropriate health care professionals, such as specialist physiotherapists.