From dismissal to partnership: patient experiences of recurrent urinary tract infection healthcare informed by the Theoretical Domains Framework and Behaviour Change Theory

Background: Recurrent urinary tract infection (rUTI) is common, debilitating, and associated with substantial negative impact on quality of life. Despite this, rUTI healthcare is often experienced as fragmented, dismissive, and poorly aligned with patient needs. Applying behavioural theory to systematically identify modifiable intervention targets offers a promising but unexplored approach to improving rUTI care. Objective: To explore patient experiences of rUTI healthcare in the UK, identify barriers to and facilitators of quality care, and generate theory-informed targets for behaviour-change intervention and service improvement. Design: Qualitative interview study using reflexive thematic analysis, followed by deductive mapping of themes to the Theoretical Domains Framework (TDF), Behaviour Change Technique Taxonomy (BCTT), and Behaviour Change Intervention Ontology (BCIO). Setting and participants: Semi-structured one-to-one interviews with 26 adults living with rUTI in the UK, with the interview schedule informed by the TDF. Results: Four barrier themes revealed systematic challenges: 'Struggling with the System,' 'Unheard Voices,' 'Shouldering Blame,' and 'Forced to Become an Expert.' Together, these captured how diagnostic limitations, fragmented services, clinical dismissal, and individualised blame compel people living with rUTI into self-advocacy experienced as exhausting. Four facilitator themes demonstrated that quality care is achievable: 'Feeling Validated,' 'Partners in the Puzzle,' 'Continuity and Connection,' and 'Expanding the Toolkit.' All 14 TDF domains were implicated, most frequently 'social influences,' 'beliefs about consequences,' 'environmental context and resources,' and 'knowledge,' indicating improvement requires both system restructuring and interpersonal skill development. Mapping to BCT Taxonomy and BCIO identified specific intervention techniques targeting these domains. Conclusion: People living with rUTI face structural and relational challenges in healthcare that compound illness burden. When individuals feel believed, involved, and supported, rUTI healthcare experiences are transformed. By integrating reflexive thematic analysis with behavioural theory, this study demonstrates that improving rUTI care requires attention to both system-level factors such as diagnostic flexibility, service continuity, and treatment options, alongside relational factors, particularly validation and shared decision-making. These findings provide a theoretically grounded foundation for intervention development, with broader relevance for chronic conditions characterised by diagnostic uncertainty.