• Donna M Lecky, Meredith K D Hawking, Cliodna A M McNulty, and ESBL steering group.
• Public Health England Primary Care Unit, Gloucester.
• Br J Gen Pract. 2014 Nov 1; 64 (628): e684-93.

BackgroundStool specimen collection is challenging and informal feedback has indicated that participants find the process difficult. Increasing stool specimen returns would improve the investigation of outbreaks of diarrhoeal and food-borne disease.AimTo explore the barriers to stool sample collection and specimen return to ascertain which factors may help to improve the process.Design And SettingQualitative patient interview study in Gloucester, UK.MethodA two-stage purposive sampling process was used to identify patients who had either previous experience or no experience of collecting a stool sample. The interview schedule, based on the theory of planned behaviour, was used to facilitate interviews with 26 patients. Interview transcripts were analysed using a modified framework analysis.ResultsBarriers to collection included embarrassment, fear of results, concerns around hygiene and contamination, discretion and privacy, and lack of information. Personal gain was identified as the main incentive to collecting and returning a stool sample. The need for an information leaflet on stool collection was emphasised by most patients.ConclusionsGPs could make a number of small changes that could make a big difference for patients and potentially increase stool sample return. If they, rather than receptionists, distributed collection kits it may be easier for patients to ask any questions they had regarding collection. In addition, the provision of a stool-collection information leaflet could increase patients' confidence regarding collecting the sample, and providing drop-off boxes for specimens could help prevent patients' embarrassment regarding handing their stool over to a receptionist.© British Journal of General Practice 2014.

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