Degefa Meaza Girma, Bezabih Afework Mulugeta, Kahsay Znabu Hadush, Belachew Abate Bekele
Department of Public Health, College of Medicine and Health Sciences, Wachemo University, Hossana, Ethiopia.
Department of Nutrition and Dietetics, School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia.
BMC Nutr. 2021 Oct 13;7(1):58. doi: 10.1186/s40795-021-00463-x.
Nutrition has a substantial role in the prevention, treatment, and cure of tuberculosis. Thus, nutrition assessment, counseling, and support (NACS) have been implemented as part of tuberculosis treatment. However, evidence on the barriers and facilitators (enablers) of its implementation is lacking.
To explore barriers and facilitators of implementation of NACS for tuberculosis patients.
An exploratory qualitative study was conducted in public health facilities and health offices of Mekelle City, Northern Ethiopia. We conducted 17 interviews using purposively selected key informants comprising health professionals (n = 12) and tuberculosis patients (n = 5). Interviews were tape-recorded, transcribed verbatim, and coded and analyzed using a thematic approach in ATLAS.ti 7 software.
Barriers were identified at three levels -organization, care provider, and patient levels. Suboptimal nutritional supply, lack of supportive supervision, lack of adequate workforce, staff turn-over, the sudden withdrawal of partners, and weak link with social service were the barriers at the organization level. Lack of commitment was reported as the only barrier at the care provider level, and socioeconomic status of patients, sharing and selling of supplies, perceived improved status, and perceived stigma were identified as the major barriers for the implementation of nutrition assessment, counseling, and support service. While training, availability of measurement and educational tools, the inclusion of nutrition indicators in the tuberculosis register, and the presence of collaborating partners were identified as facilitators at the organizational level. Patients' motivation to know their health status was reported to be a facilitator at the patient level.
Organization, care provider, and patient-level barriers and facilitators were found to influence the implementation of NACS. Hence, multilevel factors should be considered to successfully implement the program and to gain its potential impact.
营养在结核病的预防、治疗和治愈中发挥着重要作用。因此，营养评估、咨询和支持（NACS）已作为结核病治疗的一部分实施。然而，缺乏关于其实施的障碍和促进因素（推动因素）的证据。
探讨结核病患者实施NACS的障碍和促进因素。
在埃塞俄比亚北部默克莱市的公共卫生机构和卫生办公室进行了一项探索性定性研究。我们对17名经过有目的选择的关键信息提供者进行了访谈，其中包括卫生专业人员（n = 12）和结核病患者（n = 5）。访谈进行了录音，逐字转录，并在ATLAS.ti 7软件中使用主题分析法进行编码和分析。
在组织、医护人员和患者三个层面识别出了障碍。营养供应不足、缺乏支持性监督、劳动力不足、人员流动、伴侣突然离开以及与社会服务的联系薄弱是组织层面的障碍。在医护人员层面，缺乏承诺被报告为唯一的障碍，而患者的社会经济状况、物资的分享和出售、自我感觉状况改善以及感知到的耻辱感被确定为实施营养评估、咨询和支持服务的主要障碍。而培训、测量和教育工具的可用性、结核病登记册中纳入营养指标以及合作伙伴的存在被确定为组织层面的促进因素。在患者层面，患者了解自身健康状况的动机被报告为促进因素。
发现组织、医护人员和患者层面的障碍和促进因素会影响NACS的实施。因此，应考虑多层次因素以成功实施该计划并发挥其潜在影响。
