Impact of a urinary tract infection educational program in persons with spinal cord injury.

OBJECTIVE: To test the hypotheses that an educational program reduces the frequency and severity of urinary tract infections (UTIs) in persons with spinal cord injury (SCI) and impacts health beliefs, locus of control, and self-efficacy.

DESIGN: Randomized controlled study.

METHODS: Fifty-six participants were randomized to patient educational program or control groups after a 5- or 6-month baseline period. The educational program group received written material on UTIs, a self-administered test, a review by nurse and physician, and a follow-up telephone call. Data were collected monthly throughout the baseline period and the 5- or 6-month follow-up period.

OUTCOME MEASURE: The measures used were significant urine colony counts (UCCs), number of symptoms and UTIs, episodes of antibiotic treatment for UTIs, and 3 questionnaires (the Health Beliefs Questionnaire, the Multidimensional Health Locus of Control [MHLC] Scale, and a self-efficacy questionnaire).

RESULTS: When controlling for baseline counts and the difference between groups at baseline, the treatment group had significantly fewer significant UCCs than did the control group (P = 0.009). A trend also was seen for fewer symptom reports (P = 0.094) and fewer number of antibiotic treatment episodes (P = 0.232) in the treatment group. In addition, whereas the treatment group tended to have higher scores on the internal MHLC Scale (P = 0.066), they also perceived the severity of UTIs as greater than did the control group (P = 0.042) and had lower scores on the self-efficacy questionnaire (P = 0.033).

CONCLUSION: This is the first randomized controlled trial to demonstrate a significant reduction in bacterial load in the urine of persons with SCIs and an apparent reduction of symptoms and antibiotic treatment episodes for UTIs using a focused educational program. The increased scores on the internal MHLC Scale suggest that individuals in the treatment group felt that they had more control over their health behavior after receiving a UTI educational intervention.