Subramanian Sadhana, Gnanadhas Jilisha, Sarkar Sonali, Rajaram Manju, Prakashbabu Senbagavalli, Chinnakali Palanivel
Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.
Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.
BMJ Open Respir Res. 2024 Dec 5;11(1):e002576. doi: 10.1136/bmjresp-2024-002576.
The sustainable development goal (SDG) 3.3.2 prompted India to devise the National Strategic Plan 2017-2025, targeting tuberculosis (TB) eradication by 2030. The prevention pillar of this plan emphasises on Tuberculosis Preventive Treatment (TPT) for those with TB infection (TBI). Healthcare workers (HCWs), identified as one of the high-risk groups by the WHO, show a higher refusal rate for TPT. We aimed to explore the reasons for TPT refusal among the HCWs identified with TBI in Puducherry, South India during 2023.
A qualitative descriptive study was conducted among 12 HCWs from a publicly funded tertiary care hospital, each with at least 5 years of experience. Participants were selected by maximum variation sampling, based on the department of work, current TBI status and subject expertise. The in-depth interviews, guided by the health belief model, lasted approximately 45 min each. Two researchers performed manual thematic analysis using the mixed approach for coding. Codes were grouped into categories and themes. Discrepancies were resolved through discussion with a third researcher, reaching a consensus.
Three overarching themes emerged: perceived threats, beliefs regarding health interventions and empowering factors. Perceived threat elucidated the lower perceived vulnerability of contracting TB and minimal chance for progression of TBI to TB disease despite having continuous exposure and uncertainties in the workplace. Beliefs about health interventions included perceived obstacles and advantages, such as testing challenges and lack of awareness, as well as the benefits of prophylaxis and infection control measures. Empowering factors centred on prompting action and self-confidence, highlighting strategies to encourage TBI testing through administrative actions and endorsing shorter treatment plans.
Addressing the identified knowledge gaps and false perception through targeted interventions, healthcare institutions can improve TPT uptake. Implementing a comprehensive strategy that combines hospital policies to initiate screening and treatment, a supportive environment and shorter TPT regimens is essential to prevent TB among HCWs.
可持续发展目标3.3.2促使印度制定了《2017 - 2025年国家战略计划》，目标是到2030年消除结核病。该计划的预防支柱强调对结核感染（TBI）者进行结核病预防性治疗（TPT）。医护人员（HCWs）被世界卫生组织确定为高风险群体之一，其TPT拒绝率较高。我们旨在探讨2023年印度南部本地治里地区被确定为TBI的医护人员拒绝TPT的原因。
对一家公立三级护理医院的12名医护人员进行了定性描述性研究，每位医护人员至少有5年工作经验。根据工作部门、当前TBI状态和专业知识，采用最大差异抽样法选择参与者。在健康信念模型的指导下，深入访谈每次持续约45分钟。两名研究人员使用混合编码方法进行手动主题分析。代码被分组为类别和主题。通过与第三名研究人员讨论解决差异，达成共识。
出现了三个总体主题：感知到的威胁、对健康干预措施的信念和赋能因素。感知到的威胁表明，尽管在工作场所持续接触且存在不确定性，但医护人员认为感染结核病的易感性较低，TBI进展为结核病的可能性极小。对健康干预措施的信念包括感知到的障碍和优势，如检测挑战和缺乏认识，以及预防和感染控制措施的益处。赋能因素集中在促使行动和自信方面，强调通过行政行动鼓励TBI检测以及认可较短治疗方案的策略。
通过有针对性的干预措施解决已确定的知识差距和错误认知，医疗机构可以提高TPT的接受率。实施一项综合战略，将启动筛查和治疗的医院政策、支持性环境和较短的TPT方案相结合，对于预防医护人员中的结核病至关重要。
