ArticleCureus2026
Birdwatching as a Nature-Based Behavioral Strategy to Improve Adherence to Pelvic Floor Muscle Training in Women With Stress Urinary Incontinence: A Prospective Comparative Observational Study.
Article in Cureus, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Authors and funding
2 authors.
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Abstract
Background Long-term adherence remains one of the greatest barriers to successful pelvic floor muscle training (PFMT) for women with stress urinary incontinence (SUI). Although digital gamification strategies have been developed to improve adherence, they often require electronic devices and digital literacy. We evaluated whether birdwatching, as a simple nature-based behavioral strategy designed to promote motivation through environmental cueing and habit formation, was associated with improved adherence to PFMT and better clinical outcomes in women with SUI. Methods This prospective comparative observational study included women with SUI who received standardized supervised PFMT. After receiving an explanation of both management strategies, participants chose either conventional PFMT alone or PFMT combined with a birdwatching-based behavioral strategy according to their preference. The primary outcome was overall PFMT adherence during the 12-week follow-up, calculated using weather-adjusted eligible walking days. Secondary outcomes included the one-hour pad test, SUI episode frequency, Patient Global Impression of Improvement (PGI-I), and Brink scale. Clinical outcomes were evaluated after 12 weeks. Results After propensity score matching, 48 women were included in the final analysis (standard PFMT,
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