Fitzpatrick Margaret A, Solanki Pooja, Wirth Marissa, Weaver Frances M, Suda Katie J, Burns Stephen P, Safdar Nasia, Collins Eileen, Evans Charlesnika T
Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. VA Hospital, Hines, IL, USA.
Loyola University Chicago Stritch School of Medicine, Maywood, IL, USA.
Spinal Cord. 2024 May;62(5):221-227. doi: 10.1038/s41393-024-00972-z. Epub 2024 Mar 7.
Qualitative study.
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.
Three Veterans Affairs (VA) medical centers.
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.
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.
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.
定性研究。
探讨神经源性膀胱（NB）患者对尿路感染（UTI）的知识、认知和信念如何影响健康行为及医护人员的管理，并增强以患者为中心的干预措施，以改善UTI的管理。
三个退伍军人事务部（VA）医疗中心。
前一年被诊断为UTI的因脊髓损伤/疾病（SCI/D）或多发性硬化症（MS）导致NB的成年人参加了焦点小组。使用与健康信念模型相关的演绎编码和基于扎根理论的归纳编码对转录本进行编码。
23名退伍军人（SCI/D占78%；MS占18.5%）参与了讨论。出现了三个主题：（1）UTI知识；（2）影响干预环境的因素；（3）影响传播方式的因素。知识差距包括UTI预防、最能表明UTI的特定症状以及抗生素副作用。在急诊科和非VA医疗机构中，患者普遍认为医护人员缺乏关于NB的知识且医患沟通无效，而患者对居家护理有积极的看法。与UTI风险相比，患者认为抗生素风险的严重程度和发生频率较低。患者对教育的偏好包括照顾者的参与、口头和书面材料以及同伴群体等不同的环境。
了解患者的观点可增强以患者为中心的理念，并有助于采取新的干预措施，提高患者关于UTI的知识和行为。与受信任的医护人员和居家照顾者合作，以及在某些护理环境中提高对NB的了解和沟通很重要。患者教育应解决心理风险认知问题，并纳入对内容传播的偏好，以优化自我效能并强化行动线索。
