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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)Cite this article

Subjects

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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Fig. 1
Fig. 2: Major themes with links to Health Belief Model constructs and concept(s) derived from focus group discussions with persons with neurogenic bladder.

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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.

Author information

Author notes

  1. Margaret A. Fitzpatrick

    Present address: Center of Innovation for Veteran-Centered and Value-Driven Care, Rocky Mountain Regional VA Medical Center, Aurora, CO, USA

  2. Margaret A. Fitzpatrick

    Present address: Department of Medicine, Division of Infectious Diseases, University of Colorado Anschutz Medical Campus, Aurora, CO, USA

Authors and Affiliations

  1. Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. VA Hospital, Hines, IL, USA

    Margaret A. Fitzpatrick, Pooja Solanki, Marissa Wirth, Frances M. Weaver & Charlesnika T. Evans

  2. Loyola University Chicago Stritch School of Medicine, Maywood, IL, USA

    Margaret A. Fitzpatrick

  3. Loyola University Chicago Parkinson School of Health Sciences and Public Health, Maywood, IL, USA

    Frances M. Weaver

  4. Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA

    Katie J. Suda

  5. Department of Medicine, Center for Research on Healthcare, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA

    Katie J. Suda

  6. Spinal Cord Injury/Disorders Service, VA Puget Sound Healthcare System, Seattle, WA, USA

    Stephen P. Burns

  7. Department of Physical Medicine and Rehabilitation, University of Washington School of Medicine, Seattle, WA, USA

    Stephen P. Burns

  8. Department of Medicine, Division of Infectious Diseases, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA

    Nasia Safdar

  9. William S. Middleton VA Hospital, Madison, WI, USA

    Nasia Safdar

  10. College of Nursing, University of Illinois Chicago, Chicago, IL, USA

    Eileen Collins

  11. Center for Health Services and Outcomes Research, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    Charlesnika T. Evans

Authors
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Contributions

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.

Corresponding author

Correspondence to Margaret A. Fitzpatrick.

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The authors declare no competing interests.

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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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