International Medical Journal Vol. 19, No. 1, pp. 42 - 43 , March 2012
Knowledge, Attitude and Practice towards Pelvic Floor
Muscle Exercise among Pregnant Women Attending
Antenatal Clinic in Universiti Sains Malaysia
Rosediani M1), Nik Rosmawati NH2), Juliawati M1), Norwati D1)
Objectives: To determine the knowledge, attitude and practice towards pelvic floor muscle exercise (PFME) among antenatal
women in HUSM, Kelantan.
Design: A cross-sectional study.
Materials and Methods: A total of 56 antenatal women attended the antenatal clinic from March to May 2009 were given
self-administered validated KAP questionnaire on PFME.
Results: Of 56 respondents, 96.4% were Malay with the mean age of 33 years. The prevalence of urinary incontinence was
19.6%. The proportion of antenatal women with good knowledge, attitude and practice score were about 51.8%, 96.4% and
10.7% respectively. There was significant positive correlation between knowledge and practice score (p = 0.012).
Conclusion: Despite of good attitude, the overall knowledge and practice on PFME were still poor that needs more attention
from primary doctors.
pelvic floor muscle exercise, pregnancy, kegel exercise, knowledge, practice
Received on March 2, 2011 and accepted on May 20, 2011
1) Department of Family Medicine
2) Department of Community Medicine
School of Medical Sciences, Health Campus, Universiti Sains Malaysia
Correspondence to: Rosediani Muhamad
Pelvic floor muscle exercise (PFME) or kegel exercise was intro-
duced by Dr Arnold H. Kegel in 1948 in order to build up strength of
the pelvic floor muscles and improve their function: to control uri-
nary bladder and bowel motions and increase sexual satisfaction1).
This exercise is proven effective in treating stress urinary inconti-
nence in general female population2,3)in particular during antenatal
and postnatal period4). Therefore this exercise should be taught to all
antenatal mothers during antenatal visit/ classes or before they were
discharged following delivery5,6). Unfortunately to date, there is no
PFME module that can guide local health care providers to teach
antenatal mothers. Knowing the importance of it, assessing baseline
knowledge (K), attitude (A) and practice (P) of antenatal mothers on
this topic is crucial and important.
Study design and selection of participants
A cross-sectional study was conducted on antenatal women in
HUSM. A systematic random sampling was applied to antenatal moth-
ers who were 18 years and above, at 30 - 32 weeks of gestation, with
singleton pregnancy and have never been taught on PFME during cur-
rent antenatal class.
This questionnaire consisted of participants' demography, urinary
incontinence (UI) problem, knowledge of PFME: methods (5 items)
and benefits in performing it (12 items), attitude (8 items) and practice
(4 items). The Cronbach's alpha for KAP questionnaires were 0.949,
0.837 and 0.742 respectively. Categorical responses of true, false and
don't know used for K items, 5 likert scale (strongly agree to strongly
not agree) for A items and (never/seldom/frequent/always) for P items.
The scoring was reserved for negative item. The total score was cate-
gorized as good and poor based on mean of total score. This study was
approved by Ethical Committee USM and granted with USM incentive
Of 56 respondents, 96.4% were Malay with the mean age of 33
years, 12.5% were professional workers, 41% were support staffs and
more than 60% earned good monthly income. The prevalence of UI
was 19.6%. Among those with UI, 36.6% did concern on the problem
and need to use some form of protection. The proportion of antenatal
women with good knowledge, attitude and practice scores were about
51.8%, 96.4% and 10.7% respectively. There was significant positive
correlation between knowledge and practice score (p = 0.012)
It is widely known that PFME is a proven conservative therapy
C 2012 Japan International Cultural Exchange Foundation
& Japan Health Sciences University
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and it is the first line treatment for women who are suffering from
pelvic floor muscle (PFM) disorder especially UI. Despite high
prevalence of UI, not many women have good knowledge and per-
form PFME as recommended. Baharin (2005) found that 40.4 % of
women in general has UI and never seek treatment although it both-
ered them7). Pregnancy and vaginal delivery are the main risk to have
weaker PFM. The prevalence of UI during pregnancy was reported
even higher in majority of the studies ranging from 20% and 67%8-10).
This result was similar to present study, 19.6%. Thus, pregnancy is
the best time for health providers to educate women on PFME.
Unfortunately it appears not a part of syllabus in many antenatal clin-
ics/classes. This explains why the percentage of good knowledge
score in this study was only 51.2% despite majority of the respon-
dents came from good education status.
In contrast to Whitford et al. (2006), 77.9% of the respondents
got information during current pregnancy and went up to 90% if plus
the information gathered in the last pregnancy. Books were the main
source of information rather than health providers which was only
7%11). Chiarelli et al. (2003) found out 95.7% postnatal women knew
the exercise. 91% of women intended to do it but only 45% knew to
do it in adequate duration12). Since this study was done during postna-
tal, they might get the information from the antenatal classes or since
delivery. In contrast to current study, respondents were those who
never get information from antenatal clinics and the questions used
were more extensive.
In current study, 96.4% had positive attitude score, similar to
what Chiarelli et al. (2003) had found. Therefore, this is a good indi-
cator in motivating antenatal women to learn and practice PFME bet-
ter especially when the health providers teach and provide proper
training with a structured PFME program.
According to health belief model, reinforcement of positive atti-
tude by the health providers is one of the important factors to make
patient comply to the treatment given, e.g PFME. Furthermore,
Attitude-Social influence self-Efficacy (ASE) model13)believes
behavioural changes is best predicted by an individual's intention to
perform that behavior. This model assumes that behavioural intention
is determined by cognitive factors such as attitude, social influences,
self-efficiency expectation, socio-demographic, psychological, socio-
cultural and medical variables. Barriers and skills also play an impor-
tant role in determine the adherence13,14). This explanation was further
supported with the significant correlation showed in this study
between knowledge and practice.
Regarding PMFE practice, current study showed only 10.7% of
women had good practice score, 39.3% claimed frequently performed
PFME before pregnancy and 30.4% of them frequently or always
spent time to practice PFME. This result was compatible with other
studies which ranging from 17 to 54.5%10-12). The possible reasons are
women who claim know about PFME, may be do not know how to
perform it correctly since no proper class or training were given to
them and no standardized protocol checklist for PFME therapy was
produced yet. Moreover, women who did not experience PFM disor-
der, or experience mild symptoms and get less improvement after
PFME, will not well adhere to practice it15). So, in order to improve
the knowledge and practice, good clinical practice guideline should
be developed to train and guide health providers and subsequently
benefit the public.
The overall knowledge and practice on PFME were still poor that
needs more attention from primary doctors. Our antenatal women
should be informed and trained properly. Utilizing antenatal classes
to introduce simple, easy and cost effective exercise for maintaining
pelvic muscle strength is the easiest way to improve knowledge, and
yet give a positive impact on its practice and health outcome.
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