‘It’s not just thrush, it’s recurrent thrush’: a qualitative study of patient and clinician perspectives on diagnosing recurrent vulvovaginal candidiasis

BACKGROUND: Existing qualitative research reports patient dissatisfaction with diagnostic processes for recurrent vulvovaginal thrush in primary care. This dissatisfaction centres on perceived diagnostic delays and a lack of clinical awareness of guidelines. AIM: To understand how patients and healthcare professionals experience and perceive the diagnostic process for recurrent thrush in UK primary care and what can be learned to improve diagnostic pathways, clinical encounters, and patient experiences. DESIGN AND SETTING: A qualitative study of patient experiences with recurrent vulvovaginal thrush and healthcare professional perspectives about providing care was undertaken. METHOD: Qualitative interviews were conducted with 32 people who self-identified as having recurrent thrush and 25 healthcare professionals working in primary care and sexual health services in England. Data were analysed using reflexive thematic analysis to develop themes across and within the datasets. The Candidacy Framework was then applied to interpret findings in relation to access to diagnosis and care. Patient and public involvement informed topic guide development and interpretation of results. RESULTS: Differing expectations, perceptions, or understanding of recurrent thrush led patients to perceive missed opportunities in diagnostic pathways. The diagnostic process by which patients and primary care professionals identified recurrent thrush is presented through the candidacy framework stages of: identifying candidacy; navigating services and permeability; (re)appearing at services; adjudication; and offers and resistance. CONCLUSION: Diagnosis was recognised as a complex process that involved identifying patterns of recurrence, documenting this recurrence, accessing testing, interpreting test results, and forming a diagnosis as a label that opened up management pathways. Implications for practice are presented.