Acceptability of at-home urine self-testing for bladder health problems: a qualitative study

Background

Haematuria can be a sign of bladder cancer. The YORKSURe feasibility study assessed at-home haematuria dipstick self-testing to inform future effectiveness trials of screening for bladder cancer. Potential participants were mailed self-testing kits and asked to undertake 2–6 dipstick tests. Participants reported results using an app to send the image to the trial team or by phone (matching their test strip colour to a chart and entering the corresponding number). The dipstick tested five parameters and participants were randomised to reveal different panel outcomes. Those with predefined abnormal results were offered further investigation in community clinics. We qualitatively explored the acceptability of urine self-testing, self-reporting results, follow-up tests and the trial design (including revealing/concealing results) in addition to participants’ experience receiving the results and barriers and facilitators to the test.

Methods

We carried out semi-structured interviews, informed by the Theoretical Framework of Acceptability. We purposively sampled responders and non-responders by participation, test result and socioeconomic deprivation. We analysed verbatim transcripts thematically using the Framework method.

Results

We interviewed 29 people: 21 responders, 6 non-responders, and 2 people who attended an early detection clinic following abnormal dipstick findings. The idea of urine self-testing was acceptable. Many people felt capable of collecting and testing their urine and reporting the results. For others, the stipulations required to collect the urine increased the perceived complexity and the need to self-report the results made the test feel burdensome. Results were understood though some people expected more than one result. Follow-up tests for abnormal results were expected. The most common barrier to testing was timing of the invitation. The most common facilitators were interest in health and past health experiences. There were mixed views on the acceptability of concealing results and concerns around concealing abnormal results.

Conclusions

On balance, most people found the kit and self-reporting acceptable. Simplifying instructions could improve acceptability. Concealment could be further explained in any future trial.

Clinical trial registration

YORKSURe was registered with the ISRCTN on 09 June 2022 under Registration Number 34273159.