The Influence Of Delayed Voiding Behaviors On Lower Urinary Tract Symptoms In Female Nurses And An Intervention Study Based On The Peer Support Model

Objective:1.A multicenter,large-sample research study was conducted to report to report the current status of lower urinary tract symptoms and delayed voiding behaviors and to analyze the influence of delayed voiding behaviors on lower urinary tract symptoms among female nurses.2.A qualitative study was used to explore female nurses’ experiences of delayed voiding behaviors and to explore the personal and socio-cultural factors that influence female nurses’delayed voiding behaviors.3.To develop an intervention program for delayed voiding behaviors in female nurses with a peer support model,based on relevant theories,guidelines,and the unique characteristics of female nurses.4.A randomized controlled study was used to investigate the effectiveness of the intervention program to improve delayed voiding behaviors and lower urinary tract symptoms in female nurses.Methods:1.The first part was a cross-sectional study with a multi-stage sampling method to survey female nurses in 20 large tertiary hospitals in Shandong Province.A total of 13,191 female nurses’ data were included in the analysis.The Chinese version of the International Consultation On Incontinence Questionnaire-Female Lower Urinary Tract Symptoms was used to assess female nurses’ lower urinary tract symptoms,while the delayed voiding behaviors scale was used to assess their delayed voiding behaviors.Additionally,covariates that may influence the lower urinary tract symptoms of female nurses,such as socio-demographic characteristics,health-related characteristics,psychological characteristics,and work-related characteristics,were collected.Descriptive statistical analysis was conducted to present the current state of lower urinary tract symptoms and delayed voiding behaviors among female nurses.LASSO regression was applied for variable selection.Logistic regression analysis was performed to investigate the influence of delayed voiding behaviors on lower urinary tract symptoms.Dominance analysis was used to rank the relative importance of independent variables influencing lower urinary tract symptoms and to evaluate the relative significance of the effect of delayed voiding behaviors on lower urinary tract symptoms.Statistical analysis was carried out using Stata MP 17.0,with a significance level set at α=0.05 for a two-sided test.2.The second part involved a qualitative study utilizing purposive sampling to recruit 14 female nurses from a tertiary hospital in Jinan City,Shandong Province.The objective of this study was to gain insight into the experiences of female nurses regarding delayed voiding behaviors,identify potential modifiable risk factors associated with delayed voiding behaviors,and identify factors that facilitate the improvement of delayed voiding behaviors through semistructured interviews.The data collected was organized using NVivo 11.0,and thematic analysis was conducted to refine and identify common themes.3.The third part involved the development of an intervention program focused on addressing delayed voiding behaviors in female nurses,utilizing a peer support model.The construction of the intervention program was guided by the findings from previous research,literature review,theoretical principles,and the guidelines for developing peer support programs.To ensure the quality of the intervention program,it was evaluated and refined using the Delphi expert consensus method.4.The fourth part entailed the implementation and evaluation of the intervention program.This study used a randomized controlled study design.A total of 105 participants were recruited from a tertiary hospital in Jinan City,Shandong Province,and were randomly assigned to either the intervention group(n=55)or the control group(n=50).The intervention group received the intervention program for delayed voiding behaviors in female nurses based on the peer support model,while the control group did not receive any intervention.The assessment of delayed voiding behaviors and lower urinary tract symptoms was conducted at baseline,immediately after the intervention,12 weeks post-intervention,and 24 weeks post-intervention for both groups.The intervention effect was analyzed using generalized estimating equation models.Statistical analyses were performed using Stata MP 17.0 and IBM SPSS 26.0,with a significance level set at α=0.05 for a two-sided test.Results:1.Results from the initial phase of the cross-sectional study revealed the following findings:The prevalence of at least one lower urinary tract symptom among the study subjects was 51.1%.Delayed voiding behaviors occurred frequently or always in 78.0%of the study participants.Delayed voiding behaviors was a risk factor for lower urinary tract symptoms(OR=1.186,95%CI=[1.168～1.205]).Furthermore,delayed voiding behaviors accounted for 33.9%of the variance in lower urinary tract symptoms and ranked as the most significant independent variable in the Logistic regression model.2.The results of the second phase of the qualitative study yielded four overarching themes and ten sub-themes,which are as follows:Theme 1:Adverse feelings and negative coping related to delayed voiding behaviors.Sub-themes:Lower urinary tract discomfort.Reduced bladder sensation.Adoption of negative coping styles.Theme 2:Delayed voiding behaviors of female nurses were influenced by work situations and the behaviors of colleagues.Sub-themes:Occurring in work situations.Influenced by the behaviors of colleagues.Theme 3:Influence of personal perceptions and attitudes on delayed voiding behaviors.Sub-themes:Lack of knowledge about delayed voiding behaviors.Lack of understanding of the risks associated with delayed voiding behaviors.Presence of negative or positive attitudes towards delayed voiding behaviors.Theme 4:Influence of the cultural climate within nursing organizations on delayed voiding behaviors.Sub-themes:Prioritization of work over personal needs.Interpersonal relationships among nurses within the organization.3.The results of the third phase,concerning the development of the delayed voiding behaviors intervention program for female nurses,are as follows:The initial draft of the intervention program was constructed based on previous research,literature review,theoretical guidance,and peer support program development guidelines.A total of 16 experts were involved in the process,with 15 experts completing two rounds of correspondence,resulting in a response rate of 93.8%.The experts exhibited a high level of familiarity with the subject matter(familiarity level:0.84;range:0.80～1.00),and their judgment coefficient was also high(judgment coefficient:0.97;range:0.90～1.00).Moreover,the experts demonstrated a high level of authority in their judgments(authority coefficient:0.91;range:0.85～1.00).The intervention program was refined based on the opinions and feedback provided by the experts.The final version of the delayed voiding behaviors intervention program for female nurses consisted of eight themes,and 37 specific content items.The program takes the form of an Internet-based online peer support group,organized by peer supporter.The group is conducted once a week for a total of six sessions of about 30 minutes each.4.Results of the fourth part of the application of intervention programs and evaluation of effectivenessThe scores for delayed voiding behaviors in the intervention group were significantly lower than those in the control group at the immediately after the intervention,12 weeks postintervention,and 24 weeks post-intervention(mean difference=-2.466,Cohen’s d=0.908;mean difference=-2.262,Cohen’s d=0.792;mean difference=-2.959,Cohen’s d=1.028).Furthermore,the intervention group exhibited lower scores in terms of lower urinary tract symptoms(mean difference=-2.000,Cohen’s d=0.387)and urinary incontinence symptoms(mean difference=-1.094,Cohen’s d=0.373)compared to the control group at 24 weeks postintervention.Conclusion:1.High prevalence of lower urinary tract symptoms in female nurses.Delayed voiding behaviors was a common poor voiding behavior adopted by female nurses.Delayed voiding behaviors has a significant influence on lower urinary tract symptoms in female nurses.2.Delayed voiding behaviors cause multiple negative feelings for female nurses,but female nurses respond in negative ways.Moreover,delayed voiding behaviors have become normalized within the work environment,as they occur frequently in work situations and are influenced by the behaviors of colleagues.Personal factors,such as a lack of awareness and understanding of delayed voiding behaviors and their associated risks,as well as the presence of both negative and positive attitudes towards such behaviors,contribute to their occurrence.Additionally,socio-cultural factors,including a tendency to prioritize work over personal needs and the influence of peer relationships,further contribute to the manifestation of delayed voiding behaviors.3.An intervention program targeting delayed voiding behaviors in female nurses was developed using a peer support model.The program consisted of eight themes and 37 specific components.The program took the form of an Internet-based online peer support group,organized by trained peer supporters,with one group activity per week for a total of six sessions of about 30 minutes each.4.The results of the intervention program demonstrated its effectiveness in improving delayed voiding behaviors among female nurses,as well as reducing lower urinary tract symptoms.The findings suggest that the intervention program has the potential to positively impact the management of delayed voiding behaviors and lower urinary tract symptoms in this population.