OP176 ‘I think that (…) a part of self-care is being able to seek help and get it when you need it the most.’ Results from a qualitative study on enablers and barriers to self-care of urinary tract infections experienced by women living in low-income households and women from minority ethnic backgrounds

Background

Urinary tract infections (UTIs) are the second most reported reason for prescribing antibiotics in English primary care. Research pointing to misdiagnosis and overprescribing of antibiotics to treat UTIs highlights the importance of antibiotic stewardship and alternatives to antibiotics in UTI care. The UK Antimicrobial Resistance National Action Plan (NAP) includes an action specifically designed to encourage self-care and reduce patients’ expectations of being prescribed antibiotics for common infections, including UTIs. As part of a wider evaluation of the NAP, we examined the potential enablers and barriers to self-care of UTIs with a particular focus on women known to be more likely to have poorer access to health services and to the personal resources required for self-care.

Methods

We conducted a thematic analysis of data collected through four focus groups and eighteen follow-up in-depth semi-structured interviews with women with recent experience of UTIs. All women lived in low-income households or/and were from minority ethnic backgrounds. Study materials, approaches to data analysis and interpretation of findings were developed in collaboration with women lay research advisors.

Results

The women saw self-care as existing on a flexible continuum of health promotion, self-medication, and professional diagnosis and treatment rather than in strict silos. Women often relied on support from family members and friends who had either knowledge or experience of UTIs to supplement self-care. Most women described their symptoms as distressing and wanted to seek help from healthcare professionals (HCPs). Further, as there is an overlap in symptoms in UTIs and sexually transmitted infections (STIs), women often expressed worries typically related to STIs, such as concern about having their sexual practices judged and fear of partners’ unfaithfulness or partner violence. Consulting healthcare professionals was crucial in alleviating those fears.

Conclusion

Any policy to encourage self-care as a way of reducing the inappropriate use of antibiotics needs to recognise that women value consulting professionals for advice and support about their UTIs, irrespective of whether or not they receive a prescription. Efforts to better antibiotic stewardship in the context of women with UTIs should not lead to reduced access to medical diagnosis, especially among women already known to face greater barriers to accessing health services and who have fewer resources for self-care. Further, health professionals and policy-makers need to recognise that a consultation for a UTI may offer a valuable opportunity to discuss a woman’s sexual health, given that symptoms of UTIs and STIs often overlap.