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

作　　者：Jiani Zhou Quan Yuan Qingning Huang Qingya Wang Hexiang Huang Wei Chen Geng Wang Shili Liu Ting Zhang Xi Zhao Ying Li 

机构地区：[1]Department of Social Medicine and Health Service Management,Army Medical University(Third Military Medical University),Shapingba District,Chongqing Municipality,China [2]Chongqing Tuberculosis Prevention and Control Institute,Chongqing Municipality,China [3]Institute of Tuberculosis Prevention and Control,Center for Disease Control and Prevention,Guiyang,Guizhou Province,China [4]Guiyang Center for Disease Control and Prevention,Guiyang,Guizhou Province,China

出　　处：《Infectious Diseases of Poverty》2024年第4期29-47,共19页贫困所致传染病（英文）

基　　金：The study was funded by the National Natural Science Foundation of China(No.72374207);the Chongqing outstanding youth project(No.cstc2020jcyjjq0035)。

摘　　要：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 regi

关 键 词：Tuberculosis control Primary setting Implementation science Barriers and enablers Consolidated Framework forImplementation Research China 

分 类 号：R52[医药卫生—内科学] R184[医药卫生—临床医学]