URINARY TRACT INFECTION IN WOMEN AGED 18-64: DOCTORS', PATIENTS’, AND LAY PERCEPTIONS AND UNDERSTANDINGS.

Abstract

This thesis provides an insight into the problems of urinary tract infection (UTI) through the eyes of women sufferers, non-sufferers, and health professionals. It describes the use of language and metaphor in women’s descriptions. It investigates current ideas and knowledge published in academic journals, in books, and on the Internet, and assesses the quality of currently available web-based information.
The thesis is based almost entirely on qualitative methodologies. I used grounded theory for the studies of lay and professional ideas. Focus groups preceded one-to-one interviews. The study of language and metaphor is derived from lay interviews and uses discourse analysis. I based the studies of Internet information on two surveys, one year apart, of popular websites drawn from four commonly used search engines. I rank ordered popular websites and assessed information in the ‘top twenty’ using content analysis and a simple, predominantly binary, scoring system based on an internationally recognised set of criteria.
Folklore and myths, often passed down the generations, and sometimes shared by doctors, are important factors in women’s health beliefs. Early learning experiences during medical training may contribute disproportionately to doctors’ beliefs. UTIs cause embarrassment, and women rarely discuss their illness with male friends and relatives. They are also happier to discuss their problems with female health professionals, though they more commonly cite shared experience rather than embarrassment as the reason for this choice.
Since these studies were completed, a major project concluded that delayed prescriptions should be used for UTI. The natural history of this illness and women’s prior use of self-management prior to attendance suggest that this strategy may not be readily accepted.
Nurses and pharmacists are keen to manage UTI. As UTI lends itself to management by algorithm, delegation to professionals other than doctors may be effective. Easy access to antibiotics increases resistance; fear of this inhibits the implementation of devolved care.
The quality of information on the Internet is variable and some of the most popular sites score poorly when compared against recognised criteria. Better quality sites are becoming more prominent when searching the Internet through popular search engines, and efforts to improve this source of information are important.
Future research is probably best directed at information transfer and new models of delivery of care.