Home » Self-Care Promotion » Guideline on how to promote self-care: Urinary tract infection (UTI) » 2. Identify and select common and specific patients’/general population self-care behaviours

2. Identify and select common and specific patients’/general population self-care behaviours

Identify and select common and specific patients’/general population self-care behaviours that you want to promote (depending on the context problem you want to address)

2
Identify and select common and specific patients’/general population self-care behaviours

  • Specify and describe the population/patients that you want to address with the intervention
  • Identify the general and specific patients’/general population self-care behaviours that the intervention aims to promote

2.1. Specify and describe the patients/general population that you want to address with the self-care strategy

Depending on the results of the evaluation of the context and key issues and whether the strategy is general or specific to a minor condition, one should define the patients/general population that the interventions should be addressed to.

For the case of common urinary tract infection there are some specific groups that should have special considerations as they might be more vulnerable to complications or misdiagnosis:

Pregnant woman
The prevalence of asymptomatic bacteriuria in pregnant women is 2-7% (presence of bacteria in the urine, but without symptoms). In the absence of antibiotic treatment, one third of pregnant women with asymptomatic bacteriuria develop pyelonephritis. The eradication of bacteriuria lowers this risk as well as the risk of premature birth and low weight newborn.

Elderly patients
The incidence of UTI and asymptomatic bacteriuria increases with age. It is considered that asymptomatic bacteriuria is very common in the elderly, especially if they are institutionalized.

Children
It is usually caused by urinary tract malformations.

Young woman with recurrent urinary tract infection
Recurrent UTI is considered when there are at least three episodes in the last year or two in the last 6 months. More than 20% of nonpregnant women with urinary tract infection will experience a recurrence. The causes of these recurrences are usually associated with a biological predisposition and are favoured by sex-related situations and spermicides. It is also a common problem in postmenopausal women.

Men
This is much less common in men and occurs in later decades of life. However most infections in adult men are complicated and related to abnormalities of the urinary tract, although some can occur spontaneously in otherwise healthy young men [2].

2.2. Identify the general and specific patients’/general population self-care behaviours that the strategy aims to promote

A key step if you want to establish a strategy to promote self-care is to determine the ideal self-care behaviours that should be promoted. Establishing those ideal behaviours will guide the development of the strategy and it will help identifying the mechanisms that can hinder or facilitate the promotion of self-care.

Depending on the results of the analysis of your context and issues that you want to address you can identify different behaviours to promote.

The following table presents considerations specific to urinary tract infection for each of the main phases of self-care as well as some reflections regarding the patients/general population needs to achieve those goals.

All the behaviours included are considered relevant; however this classification might help to focus the self-care.

Main stages of the cycle of self-care
Main self-care behaviours to promote
Prevention and healthy lifestyles
  • Following lifestyle and hygiene measures including:
    • Ensuring appropriate intake of water.
    • Appropriate hygiene measures.
    • Appropriate clothing
    • Appropriate liquid consumption
Symptom recognition and evaluation
  • Common: Urinary frequency, dysuria and urinary urgency.
Treatment decision-making
  • Early antibiotic treatment by doctor’s prescription.

    For many patients, access to care can be difficult. Some studies have shown that some women who self-diagnose a UTI may be treated safely with telephone management. Women who have had acute uncomplicated cystitis previously are usually accurate in determining when they are having another episode. [5]

    In a RCT it was concluded that the short-term outcomes of managing suspected UTIs by telephone were comparable with those managed by usual office care. [6]

* The self-care behaviors presented in this table are focused on non-recurrent UTI. Recurrent UTI (3 UTI in the last year or two in the last 6 months) requires a different approach and treatment. In those cases consider if appropriate self-start antibiotic therapy as an additional option for women with the ability to recognize UTI symptomatically and start antibiotics. Patients could be given prescriptions for a 3-day treatment dose of antibiotics. It is not necessary to culture the urine after UTI self-diagnosis since there is a 86% to 92% concordance between self-diagnosis and urine culture in an appropriately selected patient population. Patients are advised to contact a health care provider if symptoms do not resolve within 48 hours for treatment based on culture and sensitivity. [7] [8]

Treatment adherence
  • Completing antibiotic treatment, even if symptoms subside.
Self-monitoring and early detection of complications
  • Prophylactic measures against recurrent uncomplicated UTI:
    • Hygiene measures
    • Antibiotic prophylaxis (considering: continuous antibiotic prophylaxis, self-start antibiotic). [9]
    • Postmenopausal women consider vaginal estrogen creams or rings. [7]
  • Consulting a healthcare professional if:
    • Symptoms persist after 24 hours of starting antibiotic treatment.
    • When it is accompanied by persistent fever and is suspected pyelonephritis. [7] [10]