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. 2018 Apr 10;18(1):269.
doi: 10.1186/s12913-018-3083-0.

Voices from the frontline: barriers and strategies to improve tuberculosis infection control in primary health care facilities in South Africa

Farirai Zinatsa  1 , Michelle Engelbrecht  2 , André Janse van Rensburg  3 , Gladys Kigozi  3
Affiliations

Voices from the frontline: barriers and strategies to improve tuberculosis infection control in primary health care facilities in South Africa

Farirai Zinatsa et al. BMC Health Serv Res. .

Abstract

Background: Tuberculosis (TB) infection control at primary healthcare (PHC) level remains problematic, especially in South Africa. Improvements are significantly dependent on healthcare workers' (HCWs) behaviours, underwriting an urgent need for behaviour change. This study sought to 1) identify factors influencing TB infection control behaviour at PHC level within a high TB burden district and 2) in a participatory manner elicit recommendations from HCWs for improved TB infection control.

Method: A qualitative case study was employed. TB nurses and facility managers in the Mangaung Metropolitan District, South Africa, participated in five focus group and nominal group discussions. Data was thematically analysed.

Results: Utilising the Information Motivation and Behaviour (IMB) Model, major barriers to TB infection control information included poor training and conflicting policy guidelines. Low levels of motivation were observed among participants, linked to feelings of powerlessness, negative attitudes of HCWs, poor district health support, and general health system challenges. With a few exceptions, most behaviours necessary to achieve TB risk-reduction, were generally regarded as easy to accomplish.

Conclusions: Strategies for improved TB infection control included: training for comprehensive TB infection control for all HCWs; clarity on TB infection control policy guidelines; improved patient education and awareness of TB infection control measures; emphasis on the active role HCWs can play in infection control as change agents; improved social support; practical, hands-on training or role playing to improve behavioural skills; and the destigmatisation of TB/HIV among HCWs and patients.

Keywords: Behaviour change; Healthcare workers; Infection control; Primary healthcare facilities; Tuberculosis.

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Conflict of interest statement

Ethics approval and consent to participate

Ethical approval for the study was obtained from the Faculty of Humanities, University of the Free State (Ethics reference number: UFS-HSD2016/0687). Approval for the study was also obtained from the Free State Department of Health. All participants in the study provided written informed consent, and all data was anonymised during analysis. As confidentiality cannot be guaranteed in group-based research, participants were asked to keep information discussed during the sessions confidential.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Adapted IMB model for TB infection control
See this image and copyright information in PMC

References

    1. Lönnroth K, Raviglione M. The WHO's new end TB strategy in the post-2015 era of the sustainable development goals. T Roy Soc Trop Med H. 2016;110(3):148–150. doi: 10.1093/trstmh/trv108. - DOI - PMC - PubMed
    1. UNDP (United Nations Development Programme). Sustainable development goals: 17 goals to transform our world. 2016. http://www.un.org/sustainabledevelopment/health/. Accessed 15 May 2016.
    1. RSA NDoH. South Africa’s National Strategic Plan for HIV, TB and STIs 2017–2022. 2017.http://sanac.org.za/wp-content/uploads/2017/05/NSP_FullDocument_FINAL.pdf. Accessed 19 Sept 2017.
    1. Sissolak D, Marais F, Mehtar S. TB infection prevention and control experiences of South African nurses – a phenomenological study. BMC Public Health. 2011;11:262. doi: 10.1186/1471-2458-11-262. - DOI - PMC - PubMed
    1. Jarand J, Shean K, O’Donnell M, Loveday M, Kvasnovsky C. Extensively drug-resistant tuberculosis (XDR-TB) among health care workers in South Africa. Tropical Med Int Health. 2010;15(10):1179–1184. doi: 10.1111/j.1365-3156.2010.02590.x. - DOI - PubMed

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