Abstract
Study design
Qualitative study.
Objectives
To explore how knowledge, perceptions, and beliefs about urinary tract infections (UTIs) among persons with neurogenic bladder (NB) may impact health behaviors and provider management and enhance person-centeredness of interventions to improve UTI management.
Setting
Three Veterans Affairs (VA) medical centers.
Methods
Adults with NB due to spinal cord injury/disorder (SCI/D) or multiple sclerosis (MS) with UTI diagnoses in the prior year participated in focus groups. Transcripts were coded using deductive codes linked to the Health Belief Model and inductive codes informed by grounded theory.
Results
Twenty-three Veterans (SCI/D, 78%; MS: 18.5%) participated in discussions. Three themes emerged: (1) UTI knowledge; (2) factors affecting the intervention environment; and (3) factors affecting modes of delivery. Knowledge gaps included UTI prevention, specific symptoms most indicative of UTI, and antibiotic side effects. Poor perceptions of providers lacking knowledge about NB and ineffective patient–provider communication were common in the Emergency Department and non-VA facilities, whereas participants had positive perceptions of home-based care. Participants perceived lower severity and frequency of antibiotic risks compared to UTI risks. Participant preferences for education included caregiver involvement, verbal and written materials, and diverse settings like peer groups.
Conclusions
Identifying patient perspectives enhances person-centeredness and allows for novel interventions improving patient knowledge and behaviors about UTIs. Partnering with trusted providers and home-based caregivers and improving NB knowledge and communication in certain care settings were important. Patient education should address mental risk representations and incorporate preferences for content delivery to optimize self-efficacy and strengthen cues to action.
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Data availability
The United States Department of Veterans Affairs (VA) places legal restrictions on access to Veteran’s healthcare data, which includes both identifying data and sensitive patient information. The analytic data sets used for this study are not permitted to leave the VA firewall without a Data Use Agreement. However, VA data are made freely available to researchers behind the VA firewall with an approved VA study protocol. For more information, please visit https://www.virec.research.va.gov or contact the VA Information Resource Center (VIReC) at vog.av@CeRIV.
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Funding
This work was supported by The Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development Rehabilitation Research and Development Career Development Award (B2826-W to MAF) and Research Career Scientist Award (RCS 20-192 to CTE; RCS 98-35 to FMW). The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs or the United States government.
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MAF was responsible for conceptualizing, designing, and writing the study protocol; recruiting participants; conducting focus groups; extracting and analyzing data; interpreting results; and writing the manuscript. PS was responsible for assisting with focus groups, extracting and analyzing data, interpreting results, and revising the manuscript. MW was responsible for recruiting participants, assisting with focus groups, extracting and analyzing data, interpreting results, and revising the manuscript. FW was responsible for conceptualizing, designing, and writing the study protocol; interpreting results; and revising the manuscript. KJS was responsible for conceptualizing, designing, and writing the study protocol; interpreting results; and revising the manuscript. SB was responsible for conceptualizing, designing, and writing the study protocol; interpreting results; and revising the manuscript. EC was responsible for conceptualizing, designing, and writing the study protocol; interpreting results; and revising the manuscript. NS was responsible for conceptualizing, designing, and writing the study protocol; interpreting results; and revising the manuscript. CTE was responsible for conceptualizing, designing, and writing the study protocol; interpreting results; and revising the manuscript.
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Fitzpatrick, M.A., Solanki, P., Wirth, M. et al. Knowledge, perceptions, and beliefs about urinary tract infections in persons with neurogenic bladder and impacts on interventions to promote person-centered care. Spinal Cord (2024). https://doi.org/10.1038/s41393-024-00972-z
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DOI: https://doi.org/10.1038/s41393-024-00972-z
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