Health Systems Research Unit, Medical Research Council of South Africa, Cape Town, South Africa.
BMC Health Serv Res. 2011 Oct 17;11:275. doi: 10.1186/1472-6963-11-275.
Tuberculosis (TB) is a major contributor to the global burden of disease. In many settings, including South Africa, treatment outcomes remain poor. In contrast, many antiretroviral treatment (ART) programmes are achieving high levels of adherence and good outcomes. The ART programme model for maintaining treatment adherence may therefore hold promise for TB treatment. Changing treatment models, however, requires an assessment of how staff receive the new model, as they are responsible for programme implementation. Using the normalization process model as an analytic framework, this paper aims to explore staff perceptions of a new TB treatment programme modelled on the ART treatment programme.
A qualitative approach was used. Interviews and focus group discussions were conducted with clinic staff from five intervention clinics. Data were analysed initially using qualitative content analysis. The resulting categories were then organised under the constructs of the normalization process model.
Staff recounted a number of challenges with implementing the programme. Interviews and focus group discussions identified factors relating to the main categories of the normalization process model. The key issues hindering the normalisation of the programme within clinics related to the interactional workability, relational integration and skill-set workability constructs of the model. These included hierarchical relationships, teamwork, training needs and insufficient internalisation by staff of the empowerment approach included in the programme. Logistical and management issues also impacted negatively on the normalization of the programme at the clinics.
The normalization process model assisted in categorising the challenges experienced during implementation of the intervention. The results suggest that issues remain that need to be resolved before the programme is implemented more widely. Considerable work is needed in order to embed the intervention in routine clinic practice.
结核病（TB）是全球疾病负担的主要原因之一。在许多环境中，包括南非，治疗效果仍然很差。相比之下，许多抗逆转录病毒治疗（ART）方案的治疗效果很好。因此，ART 方案在保持治疗依从性方面的经验可能为结核病治疗带来希望。然而，改变治疗模式需要评估工作人员如何接受新的模式，因为他们负责方案的实施。本文使用规范过程模型作为分析框架，旨在探讨工作人员对以 ART 治疗方案为模型的新结核病治疗方案的看法。
采用定性方法。对来自五个干预诊所的诊所工作人员进行了访谈和焦点小组讨论。数据最初使用定性内容分析进行分析。然后，将生成的类别组织到规范过程模型的构建下。
工作人员讲述了在实施该方案时遇到的一些挑战。访谈和焦点小组讨论确定了与规范过程模型的主要类别相关的因素。在诊所内阻碍该方案正常化的关键问题与该模型的互动可行性、关系整合和技能可行性有关。这些问题包括层级关系、团队合作、培训需求以及工作人员对方案中包含的赋权方法的内化程度不足。后勤和管理问题也对诊所内该方案的正常化产生了负面影响。
规范过程模型有助于对实施干预措施时遇到的挑战进行分类。结果表明，在更广泛地实施该方案之前，仍需解决一些问题。为了将干预措施嵌入常规诊所实践中，需要做大量工作。
