Skip to main content

Research Repository

Advanced Search

A qualitative investigation of the acceptability and feasibility of the Public Health England urinary tract infection intervention for older adults

Jones, Leah

A qualitative investigation of the acceptability and feasibility of the Public Health England urinary tract infection intervention for older adults Thumbnail


Authors

Leah Jones



Abstract

Background and aims
Rates of Escherichia coli (E. coli) bacteraemia are rising and the highest rates of antimicrobial resistance (AMR) for urinary tract infections (UTIs) occur in older adults. In response to this, in 2017, I developed a UTI leaflet for older adults and their carers. The aim of this qualitative study was to explore the acceptability and feasibility of using this leaflet in care home and general practice settings.
Method
A qualitative study was conducted across two English regions using interviews and focus groups with care home staff, older adults, general practice staff, and other influential stakeholders (e.g. national society representatives, commissioners and experts). Interview schedules were informed by the Theoretical Domains Framework (TDF) to explore all behavioural determinants, and key topics identified in the needs assessment. Discussions reflected on experiences of using and implementing the leaflet. Inductive thematic analysis was used to develop key themes. Using a deductive approach, key themes were then grouped with their corresponding TDF domains and applied to the Behaviour Change Wheel (BCW) to make intervention recommendations.
Results
Ninety-three participants from across Gloucestershire and East Kent took part, including national and regional stakeholders. Three higher order themes emerged; use and implementation of UTI resources including the leaflet, identifying/diagnosing a UTI, and managing and/or treating a UTI. The leaflet was seen as a useful infection prevention and control tool that tended to be used alongside diagnostic tools, but was not considered appropriate for all older adults. Intentions to use the leaflet were contingent on its provision in multiple formats, and suggestions for content improvements were discussed, such as removal of alarmist terminology, inclusion of antibiotic course length, D-mannose supplements and vaginal atrophy. Barriers to implementation included lack of time and resource for commissioners to visit each care home and general practice, and poor working relationships between both settings. There were difficulties identified by care staff and general practice staff in diagnosing UTI in older adults, with a reliance on inappropriate diagnostic tests. UTI management varied across clinicians, and patients’ continence status influenced self-care and diagnosis. Hydration was perceived to be an important self-care and prevention strategy. Thus, highlighting the importance of retaining these topics in the leaflet.
Conclusions
Commissioners should provide the leaflet in electronic and hard copy formats, and promote the leaflet during training sessions for care staff and clinicians. Regional strategies should include plans for dissemination to care homes as well as targeted training and monitoring of uptake. The leaflet is now modified and being piloted for use in community pharmacy and now contains information for all ages. This leaflet contains information on antibiotic course length, D-mannose supplements and vaginal atrophy. Intervention recommendations based on BCW, include educational training resources for care staff on asymptomatic bacteriuria, UTI identification and management, interventions to improve residents’ hydration levels alongside continence regimes, diagnostic guidelines for residents with dementia, and a urine submission form for general practices which include patient age and signs and symptoms to ensure appropriate triage.

Citation

Jones, L. A qualitative investigation of the acceptability and feasibility of the Public Health England urinary tract infection intervention for older adults. (Thesis). University of the West of England. Retrieved from https://uwe-repository.worktribe.com/output/5597163

Thesis Type Thesis
Deposit Date Mar 6, 2020
Publicly Available Date Sep 8, 2020
Public URL https://uwe-repository.worktribe.com/output/5597163

Files







Downloadable Citations