Department of Social Medicine and Health Service Management, Army Medical University (Third Military Medical University), Shapingba District, Chongqing Municipality, China.
Chongqing Tuberculosis Prevention and Control Institute, Chongqing Municipality, China.
Infect Dis Poverty. 2024 Jul 8;13(1):52. doi: 10.1186/s40249-024-01222-3.
Tuberculosis (TB) is a major cause of death worldwide, and Chinese TB burden ranked the second globally. Chinese primary healthcare (PHC) sectors implement the TB Control Program (TCP) to improve active case finding, referral, treatment adherence, and health education. This study aimed to identify barriers and enablers of TCP implementation in high TB burden regions of West China.
We conducted a representative study using mixed-methods in 28 counties or districts in Chongqing Municipality and Guizhou Province of West China from October 2021 to May 2022. Questionnaire surveys and semi-structured in-depth interviews were conducted with 2720 TB healthcare workers (HCWs) and 20 interviewees in PHC sectors. Descriptive statistical analysis was used to investigate TB HCWs' characteristics, and path analysis model was utilized to analyze the impact of associated factors on TCP implementation. Thematic framework analysis was developed with the guide of the adapted Consolidated Framework for Implementation Research (CFIR) on factors of TCP implementation.
This study found that 84.6% and 94.1% of community and village HCWs had low professional titles. Based on the results of multiple regression analysis and correlation analysis, lower TB core knowledge scores (-0.09) were identified as barriers for TCP implementation in community PHC sectors, and low working satisfaction (-0.17) and low working willingness (-0.10) are barriers for TPC implementation in village PHC sectors. The results of in-depth interviews reported barriers in all domains and enablers in four domains of CFIR. There were identified 19 CFIR constructs associated with TCP implementation, including 22 barriers such as HCWs' heavy workload, and 12 enablers such as HCWs' passion towards TCP planning.
With the guide of the CFIR framework, complex factors (barriers and enablers) of TCP implementation in PHC sectors of West China were explored, which provided important evidences to promote TB program in high TB burden regions. Further implementation studies to translate those factors into implementation strategies are urgent needed.
结核病（TB）是全球范围内主要的死亡原因之一，中国的结核病负担位居全球第二。中国基层医疗（PHC）部门实施结核病控制规划（TCP），以提高活动性病例发现、转诊、治疗依从性和健康教育。本研究旨在确定中国西部结核病负担较高地区 TCP 实施的障碍和促进因素。
我们于 2021 年 10 月至 2022 年 5 月在重庆直辖市和贵州省的 28 个县/区进行了一项具有代表性的研究，采用混合方法。对 2720 名结核病医疗保健工作者（HCWs）和 PHC 部门的 20 名受访者进行了问卷调查和半结构化深入访谈。采用描述性统计分析方法调查结核病 HCWs 的特征，并采用路径分析模型分析相关因素对 TCP 实施的影响。根据改编的实施研究综合框架（CFIR），采用专题框架分析法对 TCP 实施的因素进行分析。
本研究发现，社区和乡村 HCWs 的专业技术职称分别有 84.6%和 94.1%较低。基于多元回归分析和相关分析的结果，社区 PHC 部门结核病核心知识得分较低（-0.09）被认为是 TCP 实施的障碍，而乡村 PHC 部门工作满意度较低（-0.17）和工作意愿较低（-0.10）是 TCP 实施的障碍。深入访谈的结果报告了 CFIR 所有领域的障碍和四个领域的促进因素。确定了与 TCP 实施相关的 19 个 CFIR 结构，包括 HCWs 工作量大等 22 个障碍和 HCWs 对 TCP 规划的热情等 12 个促进因素。
在 CFIR 框架的指导下，探讨了中国西部 PHC 部门 TCP 实施的复杂因素（障碍和促进因素），为高结核病负担地区的结核病规划提供了重要证据。迫切需要进一步的实施研究，将这些因素转化为实施策略。
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