Date of Conferral

8-21-2026

Date of Award

August 2026

Degree

Doctor of Public Health (DrPH)

School

Health Sciences

Advisor

Claire Robb

Abstract

Delayed removal of indwelling urinary catheters (IUCs) contributes to catheter-associated urinary tract infections, a leading healthcare-associated infection. A dot/smart-phrase communication tool, guided by the Health Belief Model construct of cues to action, to promote timely IUC removal interventions was evaluated in this quantitative, cross-sectional study. Secondary data from N = 372 adult patients with acute urinary retention in acute and critical care settings in Washington State were analyzed using SPSS Version 30. Binary logistic regression examined relationships among demographic variables, intervention-related factors (adherence within 48 hours, cosignature within 24 hours, and secure chat communication), and clinical outcomes (IUC removal and/or medication initiation or adjustment). The model explained 46% of the variance in outcomes (Nagelkerke R² = .46). Adherence to recommendations within 48 hours was the only significant predictor of clinical outcomes, B = -3.044, p < .001, Exp(B) = 0.048 (95% CI [0.027, 0.083]), indicating an approximate 95% reduction in the odds of a bad outcome. Secure chat communication significantly increased the likelihood of cosignature within 24 hours, B = 1.574, p < .001, Exp(B) = 4.824 (95% CI [3.015, 7.717]). Demographic variables were not significant predictors. These findings indicate that timely provider action, rather than communication or documentation alone, is critical to improving IUC-related outcomes. From a positive social change perspective, implementing time-sensitive, structured communication interventions may reduce preventable infections, enhance patient safety, and promote equitable, high-quality care across diverse populations.

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