Urinary catheter users (estimated at 148,000 in home care agencies the U.S.) commonly experience adverse health effects, such as urinary tract infection (UTI), blockage, dislodgement, and leakage, leading to poor quality of life indicators. Catheter-related problems often require health care utilization resulting in increased health care costs. Self-management of urine flow is an essential part of self-care for people with long-term urinary catheters and may lead to prevention or reduction of catheter-related problems and improved quality of life. Despite its importance, no research has been conducted to formulate models of urine flow self management and its relationship to catheter-related adverse health outcome, and no studies have assessed the effectiveness of interventions to improve urine flow self-management. The proposed 4-year study uses a two-arm randomized clinical trial design to test the effectiveness of a urinary flow self-management intervention developed by the PI based on previous work. A total of 160 patients will be recruited (80 each in the intervention and standard of care arms) and assessed with repeated measures over 12 months of follow-up. The experimental intervention is designed to enhance self-management of urine flow in individuals with long-term urinary catheters, with the goal of decreasing catheter related complications and enhancing quality of life. The self-management intervention will involve four contacts with a study nurse: two home visits a week apart in the first month, a follow-up telephone call two weeks later, and a final """"""""booster"""""""" home visit at 4 months. Catheter users will learn how to increase awareness and self-monitoring of their own patterns of urine flow and modify self-management behavior as needed. All three aspects of urinary self-management, i.e., awareness, self-monitoring, and self-management behaviors, are iterative and provide feedback to the patient. The intervention and research plan are informed by Social Cognitive Theory and findings from the PI's preliminary studies, and modeled on the Stanford Chronic Disease Self-Management Program. The study will be conducted at two sites: the University of Rochester and the Visiting Nurse Service of New York (NYC). The proposed specific aims of the study are to: 1) Determine the impact of the self-management intervention on health outcomes, 2) Determine the impact of the intervention on self-management behaviors, 3) Determine whether self-efficacy mediates the impact of the intervention on self-management behaviors, and 4) Assess the perceived value of the intervention by study participants. The major dependent variables include health outcomes associated with catheter problems (UTI, blockage and catheter dislodgement), health care utilization (excess nurse visits, hospitalizations, and emergency department visits), and catheter-related quality of life (QoL). If shown to be effective, the intervention will provide a much-needed prevention tool for self-care by people with long-term urinary catheters and one that can be easily scaled and implemented in a variety of care settings.
Learning to self-manage urine flow may help people prevent or minimize persistent complications from long-term indwelling urethral or suprapubic catheters. This new intervention was inductively derived from descriptive and qualitative studies based on what experienced catheter users do to prevent problems. More effective self management behaviors in this population may improve their health status outcomes, decrease heath care utilization, and enhance catheter-related quality of life.
