识别乌干达坎帕拉结核病接触者调查的障碍和促进因素：一种行为学方法。
Identifying barriers to and facilitators of tuberculosis contact investigation in Kampala, Uganda: a behavioral approach.
作者信息
Ayakaka Irene, Ackerman Sara, Ggita Joseph M, Kajubi Phoebe, Dowdy David, Haberer Jessica E, Fair Elizabeth, Hopewell Philip, Handley Margaret A, Cattamanchi Adithya, Katamba Achilles, Davis J Lucian
机构信息
Uganda Tuberculosis Implementation Research Consortium, College of Health Sciences, Makerere University, Kampala, Uganda.
Department of Social and Behavioral Sciences, School of Nursing, University of California, San Francisco, CA, USA.
出版信息
Implement Sci. 2017 Mar 9;12(1):33. doi: 10.1186/s13012-017-0561-4.
BACKGROUND
The World Health Organization recommends routine household tuberculosis contact investigation in high-burden countries but adoption has been limited. We sought to identify barriers to and facilitators of TB contact investigation during its introduction in Kampala, Uganda.
METHODS
We collected cross-sectional qualitative data through focus group discussions and interviews with stakeholders, addressing three core activities of contact investigation: arranging household screening visits through index TB patients, visiting households to screen contacts and refer them to clinics, and evaluating at-risk contacts coming to clinics. We analyzed the data using a validated theory of behavior change, the Capability, Opportunity, and Motivation determine Behavior (COM-B) model, and sought to identify targeted interventions using the related Behavior Change Wheel implementation framework.
RESULTS
We led seven focus-group discussions with 61 health-care workers, two with 21 lay health workers (LHWs), and one with four household contacts of newly diagnosed TB patients. We, in addition, performed 32 interviews with household contacts from 14 households of newly diagnosed TB patients. Commonly noted barriers included stigma, limited knowledge about TB among contacts, insufficient time and space in clinics for counselling, mistrust of health-center staff among index patients and contacts, and high travel costs for LHWs and contacts. The most important facilitators identified were the personalized and enabling services provided by LHWs. We identified education, persuasion, enablement, modeling of health-positive behaviors, incentivization, and restructuring of the service environment as relevant intervention functions with potential to alleviate barriers to and enhance facilitators of TB contact investigation.
CONCLUSIONS
The use of a behavioral theory and a validated implementation framework provided a comprehensive approach for systematically identifying barriers to and facilitators of TB contact investigation. The behavioral determinants identified here may be useful in tailoring interventions to improve implementation of contact investigation in Kampala and other similar urban settings.
背景
世界卫生组织建议在高负担国家开展常规家庭结核病接触者调查，但该建议的采用情况有限。我们试图确定在乌干达坎帕拉引入结核病接触者调查期间的障碍和促进因素。
方法
我们通过焦点小组讨论和与利益相关者的访谈收集横断面定性数据，涉及接触者调查的三项核心活动：通过结核病索引患者安排家庭筛查访视、走访家庭以筛查接触者并将他们转诊至诊所，以及评估前来诊所的高危接触者。我们使用经过验证的行为改变理论——能力、机会和动机决定行为（COM-B）模型对数据进行分析，并试图使用相关的行为改变轮实施框架确定有针对性的干预措施。
结果
我们与61名医护人员进行了7次焦点小组讨论，与21名非专业卫生工作者（LHW）进行了2次讨论，与4名新诊断结核病患者的家庭接触者进行了1次讨论。此外，我们对来自14户新诊断结核病患者家庭的家庭接触者进行了32次访谈。常见的障碍包括耻辱感、接触者对结核病的了解有限、诊所中用于咨询的时间和空间不足、索引患者和接触者对卫生中心工作人员的不信任，以及LHW和接触者的交通成本高昂。确定的最重要促进因素是LHW提供的个性化和支持性服务。我们确定教育、劝说、赋能、健康积极行为的示范、激励以及服务环境的重组为相关干预功能，有可能减轻结核病接触者调查的障碍并增强促进因素。
结论
使用行为理论和经过验证的实施框架为系统识别结核病接触者调查的障碍和促进因素提供了一种全面的方法。此处确定的行为决定因素可能有助于量身定制干预措施，以改善坎帕拉及其他类似城市环境中接触者调查的实施情况。
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