Abstract
Background Contact investigation is an important tool to identify unrecognized patients who are colonized with antibiotic‑resistant bacteria. Many Dutch hospitals include already discharged contact patients by sending them a self‑sampling request at home, incl. an information letter and sampling materials. Each hospital composes these information letters on their own initiative, however, whether discharged patients comprehend and comply with these requests remains unclear. Therefore, the aim was to provide insight into patients’ comprehension of and self‑reported compliance with self‑sampling requests post‑discharge. Methods This mixed‑methods study was performed in eight Dutch hospitals. First, the Common European Frame‑ work of Reference (CEFR) language level of self‑sampling request letters was established. Second, a questionnaire about patients’ comprehension of the letter, self‑reported compliance, and reasons for compliance or non‑compli‑ ance were sent to patients that received such a request in 2018/2019. Finally, a random selection of questionnaire respondents was interviewed between January and March 2020 to gain additional insights. Results CEFR levels of 15 letters were established. Four letters were assigned level B1, four letters B1–B2, and seven letters B2. The majority of patients reported good comprehension of the letter they had received. Conversely, some respondents indicated that information about the bacterium (18.4%), the way in which results would be communi‑ cated (18.1%), and the self‑sampling instructions (9.7%) were (partially) unclear. Furthermore, self‑reported compli‑ ance was high (88.8%). Reasons to comply were personal health (84.3%), the health of others (71.9%), and general patient safety (96.1%). Compliant patients appeared to have a need for confirmation, wanted to protect family and/ or friends, and felt they were providing the hospital the ability to control the transmission of antibiotic‑resistant bacteria. Although a limited number of non‑compliant patients responded to the questionnaire, it seemed that more *Correspondence: Juliëtte A. Severin j.severin@erasmusmc.nl Full list of author information is available at the end of the article Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright ho