| Abstrak/Abstract |
Background
The rise in multi-drug resistant tuberculosis (MDR-TB) cases indicates that it is being
transmitted as a primary infection in the general population and has been linked to the
health care environment. Studies in resource-limited countries have shown that even
simple control measures to prevent TB (tuberculosis) infection appear to be inadequately
implemented. This study aimed to assess implementation fidelity with a major focus on
adherence, knowledge, and responsiveness to TB infection and prevention control (IPC)
practices by exploring its barriers and enablers.
Methods
This research was an implementation research using a mixed-method explanatory
sequential design. We conducted a descriptive cross-sectional study of health care
workers (HCWs) working in TB and TB patients enrolled in the three hospitals with the
highest notified TB cases in Bhutan from May to August 2019 to assess the
implementation fidelity of TB IPC practices. Structured questionnaires and a
non-participatory observation checklist were used to assess adherence, knowledge, and
responsiveness of the participants. We carried out descriptive statistical analysis for
quantitative data and thematic analysis for qualitative data.
Results
The overall adherence proportion of the participants was poor, with a poor adherence
score of 82.6% by the healthcare workers and 93.1% by the patients. HCWs were judged to
have overall good knowledge. Most patients strongly agree to the perceptions about TB
transmissible through air and visitors wearing masks when they visit the facility; however,
the overall response rate score was only 33%. Two overarching themes, “poor
administrative policy” and “behavior and attitude” are identified as key barriers and
enablers to the implementation of the TB IPC.
Conclusions
There was inadequate IPC practice among healthcare workers and patients. The overall
good knowledge of the HCWs did not appear to have a positive influence on adherence.
Hence, there is a need for continuous improvement and mandatory training, surveillance,
awareness, and sensitization. |
