Urinary incontinence (UI) is highly prevalent in nursing homes (NH), yet education for residents and their care partners is rarely provided. Continence care is typically embedded in routine, task-oriented care practices rather than delivered through a structured, person-centred educational approach. This study explored residents’ and care partners’ experiences of living with and managing UI in NH and identified their learning needs and preferences for UI education to inform the development of a user-centred continence care toolkit.

A qualitative multi-site study was conducted in Belgium, Canada and Spain. A total of 38 participants took part: 23 residents (78% women; 65–97 years) and 15 informal care partners (80% women; 54–75 years). Data were collected in person through 30 semi-structured interviews and one focus group. Most residents (19/23) reported UI. Interviews explored experiences of UI, day-to-day management strategies, barriers within care contexts, and preferences for UI education. Interviews were audio‑recorded, transcribed verbatim, and analysed through an integrated cross-site qualitative analysis informed by reflexive thematic analysis and conventional content analysis.

Four interrelated themes describing experiences and care contexts, together with one cross-cutting theme on learning and education needs, were identified (Figure 1). 

Theme 1 characterised UI as time- and space-dependent, embedded in daily routines. Continence often relied on rapid toilet access or timely staff assistance, with even short delays leading to accidents. As a result, night-time, outings and unfamiliar environments heightened uncertainty and reduced residents’ confidence in leaving controlled spaces or engaging in social activities. 

Theme 2 captured the practical management of incontinence. Participants described ongoing adjustments to absorbent products, routines and coping strategies, often with limited formal guidance. Product fit, leak prevention, and dealing with odour, skin irritation or other day-to-day complications were common challenges, frequently addressed through trial-and-error. 

Theme 3 focused on dignity, privacy and relational dynamics. UI was described as highly sensitive and closely linked to a person's self-esteem, requiring discreet and respectful interactions. Feelings of embarrassment and fear of inconveniencing staff often delayed help‑seeking, while the sensitivity of the topic made private one-to-one discussions preferable to group-based communication.  

Theme 4 related to organisational and resource constraints shaping what was feasible in continence care. Staffing levels, the timeliness of help with toileting or changing, product availability and clarity about who to contact or what support could be requested influenced daily care. Delays in assistance contributed to accidents, distress and increased dependence. In some accounts, limited staff time or routines meant that product changes were used in place of timely toileting support, or that residents remained in soiled products for longer than desired. 

Theme 5 addressed learning needs and preferences for UI education. Participants prioritised clear, practical information on causes, triggers, management strategies, warning signs and communication with professionals. While both groups valued respectful interaction and opportunities to ask questions, residents generally preferred brief one-to-one discussion with simple written materials, whereas care partners were more open to flexible formats such as email or short videos.

UI in NH is experienced not only as a clinical condition but as a care practice shaped by everyday routines, access and organisational conditions. Residents and care partners preferred practical, context‑sensitive information for day-to-day management while maintaining dignity and privacy. Education about UI should therefore be concise, actionable and delivered in ways that allow questions, clarification, and respectful discussion.

A toolkit for UI management for NH residents and their informal care partners, providing practical, context‑adaptable guidance through brief person‑centred interactions and accessible materials, may strengthen continence literacy and support informed decision-making, complementing existing continence care practices in NH.