Self-management challenges and psychosocial support needs in clean intermittent catheterization: a qualitative study of individuals with neurogenic bladder and caregivers

Background: Clean intermittent catheterization (CIC) is widely regarded as the preferred approach to bladder management for individuals with neurogenic bladder (NB). Nevertheless, a considerable gap persists between evidence and clinical practice: patients and caregivers frequently encounter self-management barriers that compromise clinical outcomes during CIC. This qualitative study explores these barriers to provide an empirical foundation for developing tailored strategies that improve quality of care. Design: A descriptive qualitative study. Methods: From August to October 2025, a convenience sampling method was employed to recruit 16 participants individuals with NB or their long-term caregivers from the Department of Rehabilitation Medicine at Zhangzhou Affliated Hospital of FuJian Medical University, FuJian Province. Face-to-face semi-structured interviews were conducted, and thematic analysis was employed for data analysis. Results: Three themes and eight sub-themes were generated in this study: (1) Cognitive deficits and information dilemmas: barriers to health information delivery, a lack of personalized guidance, and cognitive biases and memory lapses; (2) Challenges in behavioral transformation: insufficient perception of risks and benefits and weakened self-management behaviors; (3) Need for an optimized health support system: greater access to psychological counseling, development of authoritative digital health education resources, and an integrated hospital-community management model. Conclusion: This study reveals the interconnected cognitive, behavioral, and psychosocial challenges that individuals with NB and their caregivers face in practicing CIC. Our findings underscore a critical need for interventions that address these specific implementation barriers. Future initiatives should focus on developing multidimensional, patient-empowering strategies that integrate personalized digital health education, ultimately to improve the quality and sustainability of CIC self-management. Impact: This study elucidates the complex practical and psychosocial challenges encountered by individuals with NB and their caregivers during CIC. Based on these findings, we propose a multi-pronged framework for improvement, targeting cognitive, behavioral, and systemic dimensions of care. This research lays a critical foundation for designing targeted, empowerment-based interventions and offers a comprehensive, system-level roadmap to bridge the persistent evidence-practice gap in CIC self-management. Reporting method: The research adheres to Consolidated criteria for reporting qualitative research (COREQ) guidelines.