Introduction and Hypothesis <p>Urinary incontinence (UI) is a common condition among middle-aged and older women. Despite well-established international guidelines for conservative treatment, patient adherence remains sub-optimal, highlighting a discrepancy between recommendations and practical implementation. This study is aimed at exploring the multidimensional factors influencing the self-management behaviors of patients with UI using the Proactive Health Behavior (PHB) framework.</p> Methods <p>A descriptive, qualitative design was used in this study. Guided by the PHB, semi-structured face-to-face interviews were conducted with 21 middle-aged and older women diagnosed with UI. Data analysis was carried out using a combination of inductive and deductive methods.</p> Results <p>A total of 7 themes and 15 sub-themes were identified. The themes were: misconception and sub-optimal behaviors; diminished subject agency and insufficient outcome perception; the inadequacy of standardized UI management; lack of social support and information sources; life pressures and time management challenges; lifestyle patterns and transformations; and historical constraints of the era. Most participants demonstrated low adherence to sustained self-management practices and limited willingness to pursue medical treatment. The study identified factors for self-management including the micro level (cognitive and motivational factors), meso level (inadequate social support), and macro level (health care system and resource constraints).</p> Conclusion <p>Self-management behaviors of middle-aged and older women with UI are influenced by multiple factors. The findings suggest that multi-level, comprehensive interventions might be needed to support women in effectively managing UI, which should focus on improving patients’ awareness, competencies, and behavioral change.</p>