(Poster 19) Perspectives on Management of Recurrent UTIs Among Black Women

Objectives: To recognize Black women’s perspectives on diagnosis, treatment, and management of recurrent urinary tract infections (UTI) in order to develop targeted interventions to reduce disparities in UTI care.

Methods: This qualitative study enrolled 12 Black-identifying women with a history of recurrent UTIs. Participants completed (1) a survey regarding demographics and history of UTI treatment and (2) a semi-structured interview with a Black physician. Socioeconomic disadvantage was determined using the validated Area Deprivation Index (ADI). Interview structure was developed using Digital Determinants of Health and Re-AIM (Reach, Efficacy, Adoption, Implementation, and Maintenance) implementation science frameworks; domains included: knowledge, cultural factors, social support, sociodemographic/environmental barriers, and facilitators to accessing treatment and prevention strategies. Interviews were analyzed by three coders using a grounded theory approach with excellent inter-rate reliability.

Results: Among the 12 Non-Hispanic Black participants, the median age was 60 years, 75% were post-menopausal, and over 90% had at least a high school education. Half of the participants were sexually active in the past year and 25% lived with a partner. The median ADI was in the 70th percentile, indicating a highly disadvantaged status. The median time between onset of recurrent UTIs and diagnosis was two years. The most commonly reported prevention strategy was increased fluid intake (83%) followed by over-the-counter products (58%) and prescription treatments (41%) (Table 1). Four prominent themes emerged from the interviews. First, although most participants lived in disadvantaged neighborhoods, they did not report challenges with healthcare access or navigation. Second, participants believed that a UTI is a sexually transmitted infection and/or is caused by bad hygiene which results in feelings of shame, social isolation, and reliance on the internet for information. Third, participants focused more on treatment for UTI, rather than prevention. Finally, participants recommended that education on UTI should be disseminated to younger women at onset of sexual activity (Table 2).

Conclusions: Despite high levels of disadvantage, this study reveals gaps in UTI management that extend beyond access to care. Increased education about the pathogenesis of UTI and awareness of the availability of evidence-based prevention strategies were identified as important needs in older Black women with recurrent UTI.