Creation and validation of an educational booklet on fundamental pelvic exercises for women with urinary incontinence

Pontes, Íris Bisof; Domingues, Elaine Aparecida Rocha; Kaizer, Uiara Aline de Oliveira

doi:10.1590/1809-2950/21007328022021

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ORIGINAL RESEARCH • Fisioter. Pesqui. 28 (2) • Apr-Jun 2021 • https://doi.org/10.1590/1809-2950/21007328022021 copy

Creation and validation of an educational booklet on fundamental pelvic exercises for women with urinary incontinence

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Female urinary incontinence is a multifactorial condition characterized by involuntary urinary loss. For its control, strengthening the pelvic floor muscles is necessary. Thus, the guidance provided through available educational material is an essential tool to facilitate the dissemination of knowledge and acceptance by the population. The study aims to create and to validate an educational booklet on fundamental pelvic exercises for women with urinary incontinence. This is a methodological study that was submitted to six expert evaluators in the area, for the content validity of the material using the Content Validity Index (CVI). Afterward, for validation with the target population, the booklet was applied to 30-women users of the Brazilian Unified Health System (SUS) and who underwent gynecological monitoring in health units. The CVI of the educational booklet ranged from 0.71 to 1.00. The evaluators made observations regarding the appearance and content of the booklet, which were accepted for the final version. In the pretest, women understood the images and the text, 83.3% of them judged the cover as attractive and all women agreed that the sequence, organizational structure, and understanding of the sentences were adequate. The illustrations were easy to understand and 100% agreed that the necessary subjects were fully addressed and the majority (96.6%) were motivated to read. The elaborated instrument proved to be effective for its use, because it meets the reality and the health need.

Keywords
Urinary Incontinence; Validation Studies; Health Education; Teaching Material

	Relevance	Clarity	Relevance	Illustration	Illustration	Layout	Layout
	Language	Language	Language	Relevance	Clarity	Relevance	Clarity
Cover and title	0.96	0.88	1.00	0.96	0.88	1.00	1.00
Presentation of the booklet	0.96	1.00	1.00	0.92	0.88	0.96	0.96
Explanation of urinary incontinence	1.00	0.96	0.96	0.83	0.83	0.96	0.96
Explanation of risk factors	0.92	0.83	0.88	0.88	0.92	0.92	0.96
Explanation of types of urinary incontinence - exertion	1.00	1.00	1.00	1.00	1.00	1.00	1.00
Explanation of types of urinary incontinence -urgency	0.92	0.92	0.92	0.88	0.79	1.00	1.00
Explanation of types of urinary incontinence -mixed	0.96	0.92	0.96	0.92	0.88	1.00	1.00
Explanation of the consequences of urinary incontinence for a woman's life	1.00	1.00	1.00	1.00	1.00	1.00	1.00
Knowing the female body - first part	0.92	0.92	0.96	0.88	0.71	0.92	0.88
Knowing the female body - second part	1.00	0.88	1.00	0.96	0.96	0.96	0.96
Exercises to improve the condition	0.88	0.88	0.96	1.00	1.00	0.96	0.92
Exercises in other positions - first part	0.96	0.88	0.96	0.96	0.96	1.00	1.00
Exercises in other positions - second part	0.96	0.88	0.96	0.96	0.96	0.96	0.96
Contraction exercise next to the bridge	0.92	0.96	0.96	0.96	0.92	1.00	0.96
Exercise of contraction with the elevation of lower limbs	0.83	0.92	0.88	0.92	0.88	0.92	0.88
Remember	0.92	0.96	0.92	0.96	0.92	0.96	0.96
Changes in habits	0.92	0.92	0.96	1.00	0.96	1.00	0.96
Remember	0.96	0.92	0.92	1.00	0.96	1.00	0.96

Questions
Question 1: Did the cover get your attention?
	Yes	83.3% (25)
	No	16.6% (4)
	I do not know	0.2% (1)
Question 2: Is the content sequence adequate?		100% (30)
	Yes	100% (30)
Question 3: Is the structure of the educational booklet organized?
	Yes	100% (30)
	No	0 (0)
	I do not know	0 (0)
Question 4: The understanding of the sentences are?
	Easy to understand	100% (30)
	Easy to understand	0 (0)
	I do not know	0 (0)
Question 5: The written content is?
	Clear	100% (30)
	Confused	0 (0)
	I do not know	0 (0)
Question 6: Is the text?
	Interesting	100% (30)
	Interesting	0 (0)
	I do not know	0 (0)
Question 7: Are the illustrations?
	Easy to understand	100% (30)
Question 8: Do the illustrations complete the text?
	Yes	100% (30)
Question 9: Do pages or sections seem organized?
	Yes	96.6% (29)
	No	3.4% (1)
Question 10: In your opinion, will any IU patient who reads this booklet understand what it’s about?
	Yes	100% (30)
Question 11: Did you feel motivated to read the booklet until the end?
	Yes	96.6% (29)
	No	3.4% (1)
Question 12: Does the educational material address the issues necessary for patients with UI who perform the exercises?
	Yes	100% (30)
Question 13: Has the educational booklet suggested you act or think about UI?
	Yes	100% (30)

Universidade de São Paulo Rua Ovídio Pires de Campos, 225 2° andar. , 05403-010 São Paulo SP / Brasil, Tel: 55 11 2661-7703, Fax 55 11 3743-7462 - São Paulo - SP - Brazil
E-mail: revfisio@usp.br

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[1] Corresponding address: Uiara Aline de Oliveira Kaizer - Av. Senator Roberto Simonsen, 985, Jardim Santa Rosália, Sorocaba - SP, Brazil - ZIP Code 18090-210 - E-mail: uiara_oliveira@hotmail.com.

Original	Suggestion of the evaluators	Decision
Cover with the title Exercícios pélvicos fundamentais para mulheres com incontinência urinária (Pelvic exercises for women with urinary incontinence)	Swap the cover image for an image showing a pelvis.	Title - Pelvic floor exercises: prevention and treatment for women with urinary incontinence.
	Change the title to Exercícios para o assoalho pélvico: prevenção e tratamento da incontinência urinária (Pelvic floor exercises: prevention and treatment of urinary incontinence).
Presentation of the booklet	Place a picture representing a woman with UI.	Replaced the figure representing a woman with UI.
UI definition: "Urinary incontinence is a loss of urine involuntarily, that is, the person cannot control the pee and ends up leaking against one's will."	Add the description of the International Continence Society.	The description of the International Continence Society was added.
Risk Factors. "Some habits or characteristics make us easier to have urinary incontinence."	"Urinary incontinence can occur due to different causes," in addition to correcting the alignment/spacing of the page.	"Urinary incontinence can occur due to different causes," in addition to correcting the alignment/spacing of the page.
	Add a page to display the three types of UI.	A page to display the three types of UI was added.
On the page on the explanation of the SUI: "It is the one that occurs the loss of pee when one makes some exertion such as coughing, sneezing and lifting heavy objects."	Replace it with "It is the one that occurs the loss of pee when we make some exertion such as coughing, sneezing and lifting heavy objects."	Replace it with "It is the one that occurs the loss of pee when we make some exertion such as coughing, sneezing and lifting heavy objects."
On the page on the explanation of the UUI: "Urgency Urinary Incontinence is a sudden and strong desire to pee."	Replace it with "It is the involuntary loss of urine preceded by a strong desire to urinate."	Replace it with "It is the involuntary loss of urine preceded by a strong desire to urinate."
	Replace it the illustration with a more representative one.	The illustration with a more representative one was replaced.
On the MUI explanation page: "When the two previous situations occur."	Replace it with "is the involuntary loss of urine when one makes some exertion and preceded by a strong desire to urinate."	Replace it with "is the involuntary loss of urine when we make some exertion and preceded by a strong desire to urinate."
	Replace it the illustration with a more representative one.	The illustration with a more representative one was replaced.
In the section on UI consequence: "the consequences are many."	Replace it with "The effects of urinary incontinence on women's lives are many…."	Replace it with "The effects of urinary incontinence on women's lives are many…."
On the explanation page about the pelvic floor: "Let's know the female body," "If we put a mirror to see the part of the intimate region of the woman, this is what will be observed."	Replace it with "Shall we know the pelvic floor muscles?."	Replace it with "Shall we know the pelvic floor muscles?."
	Replace it with "These muscles are part of the deep muscle layer of the vagina. When we put a mirror to visualize the vagina, we can observe."	Replace it with "These muscles are part of the deep muscle layer of the vagina. When we put a mirror to visualize the vagina, we can observe."
On the second page, which explains the pelvic floor: "Let's get to know the female body." "On the inside…".	Replace it with "Shall we know the pelvic floor muscles?."	Replace it with "Shall we know the pelvic floor muscles?.'
	Replace it with "At the bottom…." Request explanation of the intestines, uterus, and bladder function.	Replaced it with "At the bottom…." The explanation on the intestines, uterus, and bladder function was added.
On the first page, which explains the exercises that can be performed.	Replace it with "To improve the problem of urinary loss, there are exercises to strengthen the pelvic floor muscles that can be performed daily."	Replace it with "To improve the problem of urinary loss, there are exercises to strengthen the pelvic floor muscles that can be performed daily."
	Replace it with "During the expiration try to contract the muscles around the anus as if you were holding the poop; also contract the musculature as if you were holding the pee, keep the contraction for 6 to 10 seconds; rest for 10 seconds, and perform 8 to 12 contractions at time."	Replace it with "During the expiration try to contract the muscles around the anus as if you were holding the poop; also contract the musculature as if you were holding the pee, keep the contraction for 6 to 10 seconds; rest for 10 seconds, and perform 8 to 12 contractions at time."
On the second page, which explains the exercises that can be performed.	Replace it with "Try to perform the contraction of the pelvic floor in other positions."	Replace it with "Try to perform the contraction of the pelvic floor in other positions."
	Suggestion for transcription of the exercise steps next to the illustration.	The exercise steps next to the illustration were transcribed.
On the third page, which explains the exercises that can be performed.	Replace it with "Try this exercise."	Replace it with "Try this exercise."
	Suggestion of change of the exercise steps to "With the butt resting on the floor, contract the pelvic floor muscles as if you were holding a fart, raised the hip while still holding the fart for 6 to 10 seconds, return to the starting position and relax for 10 seconds. Perform 8 to 12 contractions at a time. Preferably, three times a day."	Suggestion of change of the exercise steps to "With the butt resting on the floor, contract the pelvic floor muscles as if you were holding a fart, raised the hip while still holding the fart for 6 to 10 seconds, return to the starting position and relax for 10 seconds. Perform 8 to 12 contractions at a time. Preferably, three times a day."
On the second page, which explains the exercises that can be performed.	Replace it with "Try this exercise."	Replace it with "Try this exercise."
	Suggestion of change of the exercise steps to "Using a medium ball between the feet without tightening, contract the pelvic floor muscles as if you were holding a fart, with legs stretched on the ground, lift the legs stretched still doing the contraction. After you get to the height you can, lower your legs, relaxing. Perform 8 to 12 contractions at a time. Preferably, three times a day."	Suggestion of change of the exercise steps to "Using a medium ball between the feet without tightening, contract the pelvic floor muscles as if you were holding a fart, with legs stretched on the ground, lift the legs stretched still doing the contraction. Lift your legs stretched while still doing the contraction. After you get to the height you can, lower your legs, relaxing. Perform 8 to 12 contractions at a time. Preferably, three times a day."
On the page about habits.	Replace it with "behavioral therapy."	Replaced it with "behavioral therapy."
On the page about habits.	Suggestion "We may change some habits to improve urinary incontinence: in addition to the exercises to strengthen pelvic floor muscles, performing behavioral changes in our life routine to treat urine loss symptoms is necessary."	Suggestion "We may change some habits to improve urinary incontinence: in addition to the exercises to strengthen pelvic floor muscles, performing behavioral changes in our life routine to treat the urine loss symptoms is necessary."
On the page about habits.	Replace it with "Attention."	Replace it with "Attention."
On the page about habits.	Suggestion "This booklet does not replace pelvic floor evaluation, as well as follow-up with specialized health professionals. If you have any complaints of urinary loss, you must seek a health professional for a consultation where they can assess the conditions of your pelvic floor and mediate the strength of this musculature. Whenever you need it, go to the nearest basic health unit to check this and other health conditions."	Suggestion "This booklet does not replace pelvic floor evaluation, as well as follow-up with specialized health professionals. If you have any complaints of urinary loss, you must seek a health professional for a consultation where they can assess the conditions of your pelvic floor and mediate the strength of this musculature. Whenever you need it, go to the nearest basic health unit to check this and other health conditions."