[Evaluation of the quality of public health nurses' community DOTS practices and its relationship with individual and organizational factors].

Objectives　By targeting the public health nurses (PHNs) who are expected to be actively involved in the implementation of community DOTS practices, we evaluated the quality of the regional DOTS practices based on the three aspects of "enhancing tuberculosis (TB) treatment adherence," "patient-centered support other than treatment," and "coordination with related organizations." We examined the individual and organizational factors that affect the quality of these practices. Further, we clarified the challenges related to the abilities of PHNs.Methods　A self-report questionnaire survey of 958 PHNs from local governments with a TB incidence rate of 15 or more was administered in 2015. This resulted in there being 410 valid responses with a valid response rate of 42.8%.　The quality of the community DOTS practices was evaluated based on the three aspects by reviewing the literature on expert PHNs for TB patient support. After a preliminary survey, each was evaluated based on a scale of 10 points. A multiple regression analysis was conducted to understand the relationship between these and the TB control implementation system (organizational factors), the experience and motivation of PHNs to support tuberculosis patients, and the learning situation (individual factors).Results　The quality of the community DOTS practices was 7.54±1.69 for "enhancing TB treatment adherence," was 6.91±1.63 for "coordination with related organizations," and was 6.68±1.53 for "patient-centered support." The scores for the first factor were higher than those for the latter two factors (P<0.05). With regard to "patient-centered support," one-fourth of the surveyed PHNs rated their practices as low. Each predictor showed a strong relationship with the quality of community DOTS practices, especially "coordination with related organizations" and "patient-centered support" (r=0.787). The significant organizational factors associated with the quality of the community DOTS practices in terms of each aspect were "making an individual support plan for TB patients" (β=0.112-0.270), "reporting own practices at the DOTS conference as a responsible PHN" (β=0.113-0.173), "attending cohort study meetings" (β=0.129-0.167), and the individual factor of "many years of experience as a PHN" (β=0.210-0.316). Additionally, in the model of "coordination with related organizations," "reading specialized books and journals" (β=0.108) was found to be significant and positively related.Conclusion　To improve the quality of the community DOTS practices based on the self-evaluation of PHNs, "patient-centered support" with a low score and high relevance to other aspects is a priority. It was also suggested that it would be useful if the PHNs participated in DOTS evaluations, developed individual patient support plans, presented support plans, and participated in performance evaluations to improve the quality of DOTS practices.