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. 2024 Jul 8;13(1):52.
doi: 10.1186/s40249-024-01222-3.

Implementation factors of tuberculosis control program in primary healthcare settings in China: a mixed-methods using the Consolidated Framework for Implementation Research framework

Jiani Zhou #  1 , Quan Yuan #  1 , Qingning Huang #  1 , Qingya Wang #  2 , Hexiang Huang  1 , Wei Chen  3 , Geng Wang  1 , Shili Liu  1 , Ting Zhang  2 , Xi Zhao  4 , Ying Li  5
Affiliations

Implementation factors of tuberculosis control program in primary healthcare settings in China: a mixed-methods using the Consolidated Framework for Implementation Research framework

Jiani Zhou et al. Infect Dis Poverty. .

Abstract

Background: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

Keywords: Barriers and enablers; China; Consolidated Framework for Implementation Research; Implementation science; Primary setting; Tuberculosis control.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig. 1
Fig. 1
Study flowchart of mixed-study in Chongqing and Guizhou. TB Tuberculosis; HCW Healthcare worker; PHC Primary healthcare
Fig. 2
Fig. 2
Adaptation of CFIR framework on factors of TCP implementation in PHC sectors. CFIR Consolidated Framework for Implementation Research; TCP Tuberculosis Control Program; PHC Primary healthcare; HCWs Healthcare workers
Fig. 3
Fig. 3
Path model of TCP implementation in PHC sectors at community level. Note: the solid line represents the path coefficient P < 0.05, and the dashed line represents the path coefficient P ≥ 0.05. BPHS Basic public health service; TB Tuberculosis; TCP Tuberculosis Control Program; PHC Primary healthcare; HCWs Healthcare workers
Fig. 4
Fig. 4
Path model of TCP implementation in PHC sectors at village level. Note: the solid line represents the path coefficient P < 0.05, and the dashed line represents the path coefficient P ≥ 0.05. TCP Tuberculosis Control Program; PHC Primary healthcare
Fig. 5
Fig. 5
Barriers and enablers identified in TCP implementation using CFIR framework in PHC sectors. CFIR Consolidated Framework for Implementation Research; CDC Centers for Disease Control; TCP Tuberculosis Control Program; PHC Primary healthcare; HCWs Healthcare workers
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