This study investigates public restroom usage and perceptions within the Kuching and Samarahan regions of Sarawak, Malaysia. Public restrooms play an indispensable role in urban infrastructure; however, their utilisation is influenced by multifaceted determinants related to hygiene, accessibility, and user comfort. The research explores how factors such as cleanliness, toilet-type preference, cleaning practices, accessibility, availability of amenities, privacy, and maintenance collectively shape individuals’ decisions to use public restrooms. Employing a qualitative approach, the study conducted semi-structured online interviews with ten participants representing diverse occupational, demographic, and cultural backgrounds. Thematic analysis revealed seven overarching themes: cleanliness, toilet-type preference, cleaning methods, accessibility, amenities, privacy, and maintenance. Cleanliness emerged as the paramount concern, with respondents underscoring hygienic conditions as the principal determinant of restroom choice. Participants exhibited varied preferences between squat and sitting toilets, highlighting the necessity of providing both to accommodate user diversity. A strong cultural inclination towards water-based cleaning methods over paper-based alternatives was observed, reflecting prevalent socio-cultural practices. Respondents unanimously emphasised the importance of inclusive restroom designs to enhance accessibility, while the unavailability of soap and tissue was a recurring source of dissatisfaction. The findings advocate for a comprehensive and user-centred restroom management framework that ensures consistent cleanliness, diverse toilet options, culturally appropriate cleaning facilities, reliable access to essential amenities, and proactive maintenance. The study concludes that aligning restroom design and management with local user preferences can significantly enhance public satisfaction and usability. Future research encompassing a broader and more heterogeneous sample across multiple locations is recommended to strengthen the generalisability of these findings.