A systematic review of behavioural interventions for prevention of recurrent urinary tract infections.

Abstract

Behavioural strategies are recommended to prevent recurrent urinary tract infections (rUTIs), but supporting evidence is unclear. To synthesise evidence on the effects of patient-facing behavioural interventions to prevent rUTIs in primary care and community settings. Systematic review of quantitative, qualitative, and mixed-methods studies in primary care and community settings. MEDLINE, Embase, PsycINFO, Web of Science, and CINAHL were searched in April 2025. Studies examining behavioural preventive interventions for UTI in adult women were included; pharmacological-only and non-behavioural studies were excluded. Findings were synthesised narratively, risk of bias was assessed using the Mixed Methods Appraisal Tool, and confidence in findings was informed by GRADE principles. Ten studies were included (2907 participants); two randomised controlled trials and eight non-randomised studies. Evidence was heterogeneous with low to very low confidence. Strongest evidence was for increased fluid intake, with one randomised controlled trial amongst women with low intake showing reduced UTI recurrence (<i>N</i>=140). Other behaviours were included in multi-component interventions but were mostly not evaluated independently or associated to outcomes. Barriers to prevention behaviours included practical, attitudinal or social factors. Evidence for behavioural interventions to prevent rUTIs is limited by variable study quality, poor reporting of intervention content, and lack of behavioural analysis. While some evidence supports increased fluid intake, other behaviours have limited evaluation. Primary care clinicians should continue to offer behavioural advice, while recognising uncertainty and tailoring support to individual circumstances.