Knowledge and attitude factors influencing primary care clinicians' diagnosis, treatment and management of urinary tract infections in women: A qualitative ‘think’ aloud study in England

The present study aimed to identify factors related to knowledge and attitudes that influence primary care clinicians' decision‐making when diagnosing, treating, and managing suspected urinary tract infections (UTIs) in women. Understanding the factors that influence clinicians' decision‐making is important for maximising health outcomes in women and reducing suboptimal use of antibiotics and antimicrobial resistance.A qualitative think‐aloud study design was employed.Semi‐structured qualitative interviews were conducted with primary care clinicians in England over Microsoft Teams. Interviews were transcribed and coded in two ways. First, clinicians' responses for each scenario were coded as either following (optimal), not following evidence‐based national guideline or incorrectly citing certain diagnosis, treatment, and management procedures (suboptimal). Second, the knowledge and attitude factors that influenced decision‐making were coded according to an empirically informed umbrella framework. Clinicians external to the study team reviewed the findings to promote their trustworthiness and utility.Ten clinicians (six female) took part. Clinicians prescribing decisions were mostly influenced by knowledge rather than attitude factors. Despite clinicians expressing high awareness of relevant evidence‐based guidelines (a knowledge factor) and high confidence (an attitude factor), more than half of their decisions (60%) were suboptimal in some way thereby impacting women's health. Most clinicians relied on their experiential knowledge rather than using evidence‐based guidelines. Our results suggest that knowledge could impede adherence, for example, where local guidelines conflict with national guidelines of when to perform a urine dipstick test.Suboptimal prescribing decisions could result from a combination of different knowledge and attitude factors leading to negative outcomes in women's health such as inappropriate treatment of asymptomatic bacteriuria in women over 65 years old. To optimise antibiotic prescribing in women, policy‐level interventions could increase concordance across local and national guidelines, or more tailored individual‐level interventions could help clinicians recognise where their experiential knowledge causes deviations from evidence‐based guidelines when diagnosing, treating and managing UTIs.