# Patient and healthcare professionals’ perceptions of educational tools to reduce urine culture contamination in outpatient clinics: a qualitative study

## TL;DR

This study developed educational tools to help patients and healthcare professionals collect urine samples correctly, aiming to reduce contamination in outpatient clinics.

## Contribution

The study introduces patient- and HCP-informed educational tools to improve midstream clean catch urine collection practices.

## Key findings

- Patients struggled with MSCC instructions, especially those with limited urogenital anatomy knowledge.
- Educational tools were seen as helpful, but physical barriers like mobility issues and obesity remain challenges.
- Assistive devices and clinic bathroom modifications were suggested to support better specimen collection.

## Abstract

Iteratively develop educational tools (instructional video and flyer) to improve midstream clean catch (MSCC) urine sample collection using patient and healthcare professionals’ input.

Multi-method qualitative study.

Outpatient clinics in Houston, Texas, United States.

Adult patients recruited from public and private clinics (n = 12). Healthcare professionals (HCP; nurses and medical assistants) (n = 12) providing care at participating clinics.

Twelve patient interviews and three focus groups with HCPs (May 2024–November 2024). Interviews discussed patient experiences using the educational tools to guide urine specimen collection. Focus groups elicited HCPs’ perspectives on the comprehensibility and utility of the tools in their respective clinics. We identified themes using directed content analysis.

We garnered insight into knowledge gaps and barriers for completing the MSCC process. MSCC instructions in existing educational tools were poorly understood by patients, especially among those with limited understanding of urogenital anatomy. Patient barriers to MSCC collection included physical difficulties due to poor urine stream control, mobility issues, and obesity. Patients and HCPs reported that our tools addressed patient gaps in understanding of MSCC instructions. Patients and HCPs also suggested that we accompany our tools with assistive devices and dedicated surfaces in the clinic bathrooms, to better meet patients’ needs in urine specimen collection.

Initial feedback was promising that our educational tools would improve the MSCC collection process for patients. In next steps, we will conduct feasibility pilot testing followed by a randomized controlled trial to test the effectiveness of reducing urine culture contamination.