Hypothesis / aims of study
Globally, there are very few intermittent catheters (IC) designed to be reused. In some countries catheters intended for single use are cleaned and re-used, although this practice is prohibited by others including the UK. Reusable/multi-use catheters combined with single-use catheters could help reduce plastic waste; in England alone >90 million catheters were discarded in 2022 (1). But if more reusable catheters were made available to IC users, would they want to use them? Understanding the willingness of IC users to try out reusable catheters will help to determine if there is a market that is sufficiently attractive to innovators and industry to develop such catheters.
We conducted a non-inferiority randomised controlled trial comparing mixed (multi/single-use) catheter management with single-use catheter management by 578 intermittent catheter users over 12 months. Participants randomised to the intervention arm were asked to combine re-use (reusing a multi-use catheter for up to 28 days with cleaning using soapy water and Milton - a commercial form of sodium hypochlorite - after each use) and single use (using their usual catheter). Those in the control arm continued with their usual single-use catheter.
The aim of this sub-study was to gain insight into the potential market for reusable catheters using trial, survey and interview data.
Study design, materials and methods
We analysed:
1. Trial recruitment data.
2. Survey data. Responses to a question about reasons for trial participation from an anonymous online survey sent to 188 participants who had expressed an interest in or completed the Trial.
3. Interview data from 32 participants who had completed or withdrawn from the Trial.
4. Expression of interest forms where IC users had recorded their reasons for declining to participate.
Results
1. Trial recruitment data: Over a 27-month period, 4946 IC users were invited to volunteer for the Trial from GP practices, nurse prescribing teams and hospital clinics in England, Scotland and Wales. Following initial eligibility checking by practice staff, 19% of invitees expressed an interest in participating in the Trial. After further eligibility checking by research staff, 12% (N=578) were both consented and randomised.
2. Survey data: Trial participants and other IC users who expressed an interest but did not take part were invited to indicate all reasons for volunteering that applied to them. Responders (N=169/188) gave a total of 497 responses. The reason most cited was Environment - to reduce plastic waste and/or reduce carbon emissions and impact on the environment (114/169) closely followed by Altruism /Research - to help improve designs of future catheters (111/169). Other reasons included Costs - to reduce costs to the National Health Service (108/169), Convenience - less to carry around e.g. on holidays and/or less to store (85/169) and Supply – to reduce problems with running out/supply (68/169). Other reasons were given by 11/169.
3. Interviews: Data from 32 participants showed that almost all wanted to use reusable catheters for environmental reasons but mainly in conjunction with single-use catheters. Themes from the interviews indicated that the ‘context’ of catheter use (e.g. at home or away) was relevant to the choice of catheter type and the theme ‘mix and match’ further illustrated the value of both single-use and reusable catheters. 'Characteristics of the catheter’ indicated the need for a greater range of designs and innovations of reusable catheters to meet individual user needs.
“I would do 90% reusable but with the backup for going on holiday or weekends away with the single use.”
“I do think the reusable ones are a massive way forward if they can make it more day to day practical”.
4. Reasons for not wanting to join the study were provided by 676 invitees who gave a total of 903 responses. Fifty-one percent of reasons were related to the person considering themselves to be unable to participate due to other health issues, being ineligible, too old or having a disability. Sixteen percent of decliners gave their reason as concern about risk of infection, the remainder gave a wide range of other reasons.
Interpretation of results
Nearly 20% of IC users who were invited expressed an interest in taking part in the Trial. The survey and qualitative data indicate that the main motivation was to reduce plastic waste or have a positive impact on the environment. This number reflects findings from a UK government report in which 18% of people were identified as ‘positive greens’ who will actively participate in attempting to improve the environment, whilst a further 12% are ‘waste watchers’ who are most concerned about reducing waste (2).
Our findings indicate that a substantial proportion of IC users would like the option of reusable catheters to use alongside their single-use ones. With increasing environmental awareness and concerns, this proportion is likely to rise. A large proportion of invited IC users declined to take part in the Trial and, although it is not certain whether they declined because they did not want to reuse or because they did not want to take part in a trial, it is likely that use of single-use catheters alone will remain the preference for many users.
There are no reusable catheters available on prescription in the UK and for trial purposes we used a CE marked catheter only available outside the UK. Our findings indicate that a range of reusable catheters with different design attributes is desirable and there is scope to introduce new technologies and materials to increase convenience and appeal to users.