A two-stage purposive sampling process was used to identify patients who had either previous experience (Group 1) or no previous experience (Group 2) of collecting a stool sample. Those included were patients aged >18 years, who had submitted a stool (Group 1) or blood sample (Group 2), as requested by a GP, to the microbiology department of Gloucestershire Royal Hospital in the 3 months leading up to the recruitment phase. Women who were pregnant or patients who were terminally ill were excluded.
Potential participants were stratified by ethnic origin, age, sex, and stool consistency (Group 1 only). White patients were selected randomly from each stratified list. All patients of non-white ethnicity were invited to take part due to their low numbers. The researchers aimed to recruit up to five participants from each stratum.
How this fits in
Stool specimen collection is needed to inform the management of many gastrointestinal diseases and infections, but returns by patients are generally <60%. Through interviews based on the theory of planned behaviour with patients who had and had not submitted stool specimens, it was found that personal attitudes, subjective norms, and perceived behavioural controls all influenced specimen return. Patients perceived that handling stools was dirty and embarrassing, and it was found that a lack of information about why patients were collecting the stool, how to do it, receptionist involvement, privacy during returning specimens, and fear of results were all barriers to collection. Stool specimen returns may be increased through greater explanation about the reason for collection by the GP, providing the patient with plastic gloves (or telling them where to get them), and giving the patient Public Health England’s patient information leaflet on stool collection, which includes diagrams and opaque bags for return.
Invitation letters containing study information from the local microbiologist and Public Health England Primary Care Unit (PCU) were sent to all selected patients. Letters describing the study were also sent to each participant’s GP practice. Willing participants provided written informed consent. Telephone calls were used to organise interview dates and venues. Patients were reimbursed for their time with a £10 voucher.
