Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Department of Otorhinolaryngology-Head and Neck Surgery, Aminu Kano Teaching Hospital, No. 2 Hospital Road, off Zaria Road, PMB, Kano, 3452, Nigeria.
BMC Health Serv Res. 2022 Feb 3;22(1):142. doi: 10.1186/s12913-022-07536-y.
Nigeria has a high burden of Tuberculosis (TB) including Drug-resistant Tuberculosis (DR-TB) and hearing loss. Despite several efforts directed toward its control, many patients fail to respond to treatment, having developed DR-TB. Lack of adherence to the DR-TB guidelines/improper implementation of the guideline has been identified as one of the factors impeding on effective treatment. This study sought to measure the implementation fidelity of health workers to management guidelines for hearing loss resulting from DR-TB treatment and to identify its determinants.
A questionnaire-based cross-sectional study was conducted at the Infectious Disease Hospital, Kano. Implementation fidelity of the Programmatic Management guidelines for the treatment of Drug-resistant Tuberculosis was measured under the four domains of content, coverage, duration and frequency. The determinants examined are intervention complexity, facilitation strategies, quality of delivery and participant responsiveness as proposed by the Carroll et al. framework. Other determinants used are age, sex, professional cadre and work experience of healthcare providers.
The Implementation fidelity score ranged from 40 to 64% with a mean of 47.6%. Quality of delivery, intervention complexity, participants' responsiveness, and being a medical doctor exerted a positive effect on implementation fidelity while facilitation strategy, age and work experience exerted a negative effect on implementation fidelity.
The implementation fidelity of management guidelines for hearing loss resulting from DR-TB treatment was low. Implementation fidelity should be assessed early and at intervals in the course of implementing the Programmatic Management of Drug-resistant Tuberculosis guideline and indeed, in the implementation of any intervention.
尼日利亚结核病（TB）负担沉重，包括耐药结核病（DR-TB）和听力损失。尽管为控制结核病做出了多项努力，但许多患者因发展为 DR-TB 而未能对治疗产生反应。缺乏对 DR-TB 指南的遵守或对指南的不当执行已被确定为阻碍有效治疗的因素之一。本研究旨在衡量卫生工作者对 DR-TB 治疗引起的听力损失管理指南的实施情况，并确定其决定因素。
在卡诺传染病医院进行了一项基于问卷的横断面研究。根据 Carroll 等人提出的框架，在内容、覆盖范围、持续时间和频率四个领域测量了《耐多药结核病治疗规划管理指南》的实施情况。检查的决定因素是干预的复杂性、促进策略、交付质量和参与者的响应性。使用的其他决定因素是医疗保健提供者的年龄、性别、专业职务和工作经验。
实施一致性评分范围为 40%至 64%，平均为 47.6%。交付质量、干预复杂性、参与者的响应能力和作为一名医生对实施一致性产生积极影响，而促进策略、年龄和工作经验对实施一致性产生负面影响。
DR-TB 治疗引起的听力损失管理指南的实施一致性较低。在实施耐药结核病规划管理指南以及实施任何干预措施的过程中，应尽早并在间隔时间评估实施一致性。
