Abstract
Carrying heavy loads increases the risk of pelvic organ disorders, particularly in low-income countries. Low self-efficacy hampers adoption of pelvic-floor-protective behaviors. The enabling hypothesis suggests that social support may strengthen women's behavioral self-efficacy. A three-arm parallel non-randomized controlled trial with 300 women and their social partners experimentally examined whether self-efficacy and social support can enable women's pelvic-floor-protective behaviors in rural Nepal. Three villages received (1) self-efficacy (2) self-efficacy and social support promotion, or (3) information only control. The co-primary outcomes were reduced weight carried and using protective lifting techniques at 2-month follow-up. Self-efficacy promotion increased the use of protective lifting techniques 9% more than information only (d = 0.28). Weight was reduced by 3 kg more when additionally promoting social support compared to self-efficacy alone (d = 0.39). Self-efficacy and social support promotion enable women to better protect their pelvic floor health and may complement educational approaches to health behavior change in low-resource populations.