What’s the catch? Urine sample collection from young pre-continent children: a qualitative study in primary care.

Abstract

Background: Urinary tract infections (UTIs) are common in young pre-continent children, but collecting urine samples is challenging. Collection methods all have limitations and international guidelines have conficting recommendations. Choice of method must balance time, resources, invasiveness, reliability, and contamination. Evidence from primary care clinicians is limited regarding barriers and enablers to sample collection, and what factors inform the choice and use of different sample collection methods. Aim: To understand the barriers and enablers to collecting urine samples from young pre-continent children in primary care. Design & setting: An exploratory qualitative study performed in primary care in Australia. Method: Semi-structured interviews explored the topic of collecting a urine sample from a child aged 6 months who presented with a fever. The interviews were undertaken with 21 GPs and four practice nurses (PNs) until data saturation was reached. Interviews were audiorecorded, transcribed verbatim, coded, and underwent content and thematic analysis. Results: Five main themes emerged including: the clinician’s knowledge and expertise; patient characteristics; parent or carer’s understanding and motivation; the collection process itself; and likely outcome of the chosen method. Non-invasive methods were strongly favoured; although, clean catch was considered time-consuming and urine bags were known to be often contaminated. Invasive methods (for example, catheterisation or suprapubic aspiration [SPA]) were rarely performed outside of remote settings. Key barriers included time and space constraints in clinics, and key enablers included parental motivation, education handouts, and voiding stimulation methods. Conclusion: This study has identifed key barriers and enablers to inform education, policy, and future research for urine sample collection from pre-continent children in primary care. Guideline recommendations must consider the primary care context to ensure they are relevant and suited to real-world practice.