We interviewed 30 participants, each lasting approximately 30 minutes. Four main themes were identified when examining patient experiences of providing a urine specimen for diagnosing a UTI (Table 2).
Theme 1: Straight forward urine collection
For interview question 1, each participant spoke about being able to provide a urine sample that was easy and straightforward. The naturally voided method was repeatedly referred to and was regarded as being the most straightforward of all of the sampling methods. Many of the participants talked about being able to provide a urine specimen that was not labour intensive or painful. Participants shared their views on natural voiding by referring to the collection method as‘’ easy’’ (Participant 3867). However, other participants were more explicit when describing the method.
‘’ It’s not a problem you just open your legs and let it all out’’ (Participant 3458).
‘’I prefer urinating into the pot. It’s straightforward’’ (Participant 2365).
Participants often mentioned being able to provide a urine sample that was quick and easy, especially as LUTS were the primary reason for them attending the medical urology centre. The MSU and the Peezy method were not considered straightforward compared to the natural void. There were mixed views towards the MSU as some participants found the MSU method challenging and expressed concerns.
‘’You wonder whether you have done it right’’ (Participant 2906).
‘’The midstream is awkward because you don’t know when you catching the midstream’’ (Participant 2287).
‘’The midstream I don’t like because if you lose the urine whilst getting the midstream you lose it all over your hands’’ (Participant 3121).
Straightforward urine collection was considered the best way for obtaining a urine specimen. It was clearly established that participants were more enthusiastic about providing a urine specimen that was easy and straightforward to perform. Although they were familiar with the MSU, there remained uncertainties with the collection technique.
The Peezy MSU™ was regarded as complex and was not the easiest method for obtaining a urine sample and participants frequency expressed their views on the complexities of the device.
‘’ I wasn’t keen on the peezy as I needed an extra pair of hands, and I didn’t trust the instruction provided in the pack’’ (Participant 3600).
‘’ I didn’t like the peezy because I couldn’t work out how it worked and I was worried it was going to disconnect and I would end up peeing all over the floor’’ (Participant 4014).
‘’The MSU peezy; It was confusing; I needed a demonstration of how to use the device. I wasn’t sure whether I was to stand up or sit down when using the device’’ (Participant 4265).
Theme 2: Painful urine specimen collection
As a majority of the participants attending the centre had painful bladder symptoms, the experience of having the catheter inserted into the bladder brought back the memory of that pain. For interview question 2, participants commonly described their experiences of being catheterised as painful and uncomfortable. The pain symptoms were described only in the catheter method and not in the MSU, Peezy MSU™ or natural void methods as these methods were all non-invasive. Participants described their dislike towards the catheter method.
‘’I don’t particularly like the catheter because it’s scary even though it’s not and feels as though you might get an infection’’ (Participant 3499).
‘’ It’s slightly uncomfortable. When it’s taken out it has a strange sensation’’ (Participant 2584).
The majority of the participants experienced a great deal of pain with the catheter collection method. In addition it infringed on their privacy due to the way in which the specimen was collected, and participants highlighted this point.
‘’The catheter was a bit invasive and it hurt’’ (Participant 2977).
As the catheter technique was believed to produce the optimal specimen, the pain associated with the method was endured for the purpose of obtaining an uncontaminated specimen.
Theme 3: The optimal specimen collection
The catheter was regarded as the urine collection method that produced the best specimen for diagnostic testing. When asked, what method of urine collection do you think provided the most clean sample and why? The participants responded positively.
‘’The catheter of course. Because it’s not touching anything to pick up any germs’’ (Participant 3458).
‘’Probably the catheter because your introducing it straight into the urethra and there are no chances of germs entering’’ (Participant 3963).
A majority of the participants were adamant that the catheter was a better method and could not compare to the non-invasive methods. Although there were no overt claims that the catheter specimen was less likely to contain contaminants, there were subtle remarks suggesting that the catheter is a superior method.
‘’The catheter went straight in and eliminated areas where it could get contaminated’’ (Participant 3600).
‘’The catheter provided the cleanest sample as it is all internal and it’s the cleanest way of collecting the sample’’ (Participant 4014).
‘’I would have thought that the catheter would provide the opportunity to be uncontaminated, and provide the cleanest sample’’ (Participant 3456).
As more interviews were conducted it emerged that participants thought that the method of how the catheter was inserted into the bladder would bypass the chances of specimen contamination and because of this, strongly believed that the catheter sampling method was the optimal specimen for identifying a UTI.
Some of the participants did not consider the other three methods could compete with the catheter and shared their experiences. There was a strong census that the catheter specimen was a superior specimen collection method and this was evident through the comments of each participant.
‘’ Surely the other methods were not as good at getting a cleaner sample like the catheter?’’ (Participant 4300).
‘’There is a likelihood of contamination from the other methods’’ (Participant 2131).
‘’ The other methods would most probably pick up germs, which the catheter wouldn’t’’ (Participant 3458).
Theme 4: Simple urine collection methods as standard practice
Participants’ agreed that they would like a urine collection method that would be easy and straightforward to perform. A majority of the participants considered that the natural void should be the standard method in clinical practice for patients without a complex bladder, unlike them who require specialist treatment interventions.