Barriers, beliefs, and behaviour

: a mixed-methods study of physical activity in women with urinary incontinence

Abstract

Urinary incontinence (UI) is an often-overlooked barrier to women’s physical activity (PA), substantially impacting physical, mental, and social well-being. Despite robust evidence supporting health benefits, PA is reduced, and symptoms are underreported among women, often leaving UI neglected in interventions. This research sought to explore the PA behaviours of women with UI by investigating PA barriers and facilitators. To better understand the psychological constructs shaping behaviour and to evaluate the efficacy of a tailored intervention to support engagement, a mixed-methods approach was undertaken across 3 studies. Surveys and semi-structured interviews identified barriers and facilitators to PA in Study 1, providing foundational insights into social, psychological, and environmental challenges. Study 2 tested the validity and reliability of the Health Action Process Approach in predicting the PA behaviours of women with UI by measuring psychological constructs such as self-efficacy and action planning. Study 3 pilot tested a tailored "pelvic-floor friendly" group PA intervention, using survey and focus group data to assess its impact on women’s PA behaviours, confidence, and social inclusion. The findings highlight the pervasive impact of UI on PA, with stigma and embarrassment emerging as significant barriers and low self-efficacy and fear of leaking impeding the transition from intention to engagement. Through intervention participation, women’s confidence improved, fear reduced, and the enjoyment of group PA was re-established. Improvements were achieved due to the intervention’s low-impact exercises, pelvic health education, and a supportive PA environment. Across all studies, social connections and knowledgeable instructors were critical facilitators, while practical adjustments, such as accessible facilities and flexible class timings, further enabled participation. By addressing physical, psychological, and social dimensions of UI, the importance of promoting long-term PA engagement in women with UI is highlighted. The thesis findings provide a strong foundation for researchers, decision-makers, and practitioners to create women-centred PA interventions that enhance quality of life and health outcomes.

Date of Award	18 Jun 2025
Original language	English
Awarding Institution	Abertay University
Sponsors	Carnegie Trust for the Universities of Scotland
Supervisor	David Lavallee (Supervisor), James Moir (Supervisor), Luis Calmeiro (Supervisor) & Yvette Wharton (Supervisor)