Bridging the awareness-action gap in pelvic floor prehabilitation: cognitive barriers and facilitators for asymptomatic populations—a perspective

Pelvic floor disorders (PFDs), including urinary incontinence and pelvic organ prolapse, represent a widespread public health concern with substantial implications for functional status and quality of life. Evidence supports the efficacy of prehabilitation-a proactive strategy focused on preventing dysfunction before clinical onset-through screening and early intervention. However, its implementation in asymptomatic populations remains limited, largely due to a pervasive "awareness-action gap" wherein knowledge fails to translate into behavioral engagement. This perspective article systematically examines the cognitive, psychosocial, and structural determinants that act as barriers or facilitators to participation in pelvic floor health initiatives. By integrating the Health Belief Model and Nudge Theory, this study investigates factors influencing health engagement. The framework identifies major barriers, including asymptomatic complacency, knowledge gaps, low self-efficacy, and systemic obstacles. It also highlights potent facilitators, such as targeted message framing, cognitive schema alignment, credible messengers, and purposeful choice architecture. We further propose a multilevel framework for bridging this gap, combining targeted health communication, clinical integration of preventive protocols, digital health tools, and supportive policy reforms. Ultimately, transforming awareness into sustained action will require a coordinated effort across health systems, incorporating evidence-based behavioral interventions and aligning incentives to establish pelvic health promotion as a public health priority.