This observational study was conducted at a single center and involved patients who had undergone TUR-BT for NIMBC at a tertiary hospital between May 2022 and February 2024. Subsequently, these patients underwent cystoscopic follow-up every three months. The Institutional Review Board of Istanbul Medeniyet University School of Medicine has approved this study (Number: 2022/0324, Date: 18.05.2022). All participants were given a comprehensive overview of the study’s aims and methodologies and were requested to provide written consent. The participants were guaranteed confidentiality of their information, and the study followed the ethical guidelines outlined in the Declaration of Helsinki.

Figure 1 illustrates the study selection process. Data were collected via in-person interviews in which participants responded to a questionnaire administered by a chef resident. At the beginning of the study, participants were asked various questions to gather sociodemographic data, including age, body mass index (BMI), education level, family income, internet usage, and adherence to cystoscopy.

Study Flowchart for Participant Tracking

We included the presence of NIMBC in patients who underwent TUR-BT and subsequent pathological examination. Patients were excluded if they met any of the following criteria: age ≥ 80 years, diagnosis of metastasis, pathological results showing invasive bladder cancer, limited follow-up period (< 6 months), dropouts, cognitive impairments or difficulties in language and comprehension, declined to participate in the study, severe cardiovascular disease, or advanced respiratory illness. Additionally, considering that the complexity of regimen maintenance, BCG treatment, and second-look TUR could affect QoL, we excluded these patients from the study.

This eight-item e-Health Literacy Scale (e-HEALS) exam assesses consumers’ capacity to discover, analyze, and apply electronic health information to their health issues. Each feature of the measure was evaluated using a Likert scale ranging from one to five. Three question scores were added to obtain a DHL score. The scale values vary from 8 to 40, with high scores indicating high DHL [7].

The HLS-Q12, a validated and abridged version of the European Health Literacy Survey Questionnaire, was used to determine the HL levels. It comprises 12 questions intended to assess a person’s confidence and competence in handling various health circumstances. Patients rated the complexity of each circumstance on a four-point Likert scale, from simple to complex, with a higher score signifying higher HL proficiency [8, 9].

The Turkish version of the European Organization for Research and Treatment of Cancer (EORTC) QoL Questionnaire (QLQ)-C30 was administered six months after TUR-BT. The questionnaire consisted of 30 questions divided into five functional dimensions: physical, role, emotional, cognitive, and social. There were also three symptom measures (fatigue, pain, and nausea/vomiting) and a general health status section. The six sections address various symptoms, including shortness of breath, loss of appetite, sleep difficulties, constipation, diarrhea, and financial concerns [10]. All surveys were examined in accordance with their respective scoring guidelines. The BMI was divided into three groups based on WHO criteria [11].

Educational attainment was classified according to the International Standard Classification of Education (ISCED) of the United Nations Educational, Scientific, and Cultural Organization [12]. The 2023 governmental mandate sets a national minimum wage of $10,000 based on income classification.

After discharge, patients were assessed in the outpatient clinic in their third month for routine cystoscopy follow-up, according to the European Association of Urology guidelines. Patients were classified into two groups according to their adherence to the cystoscopy follow-up protocol: compliant and non-compliant. Each patient who did not receive the cystoscopic follow-up was identified: as “non-compliant”. We relaxed the definition to include compliance with cystoscopic follow-up at any time within 90–120 days of TUR-BT.

We used the average and standard deviation to analyze continuous variables, and percentages to assess categorical variables. The normal distribution of continuous variables was assessed using the Shapiro-Wilk and Kolmogorov-Smirnov tests. One-way ANOVA was used to analyze differences between groups in continuous variables. To examine multiple continuous variables, a multivariate analysis of variance was used. Statistical analysis of continuous variables included the application of Mann–Whitney U and Kruskal–Wallis tests, with statistical significance set at p < 0.05.