Identifying barriers to and facilitators of tuberculosis contact investigation in Kampala, Uganda: a behavioral approach

Background The World Health Organization recommends routine household tuberculosis contact investigation in high-burden countries but adoption has been limited. We sought to identify barriers to and facilitators of TB contact investigation during its introduction in Kampala, Uganda. Methods We collected cross-sectional qualitative data through focus group discussions and interviews with stakeholders, addressing three core activities of contact investigation: arranging household screening visits through index TB patients, visiting households to screen contacts and refer them to clinics, and evaluating at-risk contacts coming to clinics. We analyzed the data using a validated theory of behavior change, the Capability, Opportunity, and Motivation determine Behavior (COM-B) model, and sought to identify targeted interventions using the related Behavior Change Wheel implementation framework. Results We led seven focus-group discussions with 61 health-care workers, two with 21 lay health workers (LHWs), and one with four household contacts of newly diagnosed TB patients. We, in addition, performed 32 interviews with household contacts from 14 households of newly diagnosed TB patients. Commonly noted barriers included stigma, limited knowledge about TB among contacts, insufficient time and space in clinics for counselling, mistrust of health-center staff among index patients and contacts, and high travel costs for LHWs and contacts. The most important facilitators identified were the personalized and enabling services provided by LHWs. We identified education, persuasion, enablement, modeling of health-positive behaviors, incentivization, and restructuring of the service environment as relevant intervention functions with potential to alleviate barriers to and enhance facilitators of TB contact investigation. Conclusions The use of a behavioral theory and a validated implementation framework provided a comprehensive approach for systematically identifying barriers to and facilitators of TB contact investigation. The behavioral determinants identified here may be useful in tailoring interventions to improve implementation of contact investigation in Kampala and other similar urban settings. Ausführliche Beschreibung

Gespeichert in:

Autor*in:	Ayakaka, Irene [verfasserIn] Ackerman, Sara Ggita, Joseph M. Kajubi, Phoebe Dowdy, David Haberer, Jessica E. Fair, Elizabeth Hopewell, Philip Handley, Margaret A. Cattamanchi, Adithya Katamba, Achilles Davis, J. Lucian

Format:	E-Artikel
Sprache:	Englisch

Erschienen:	2017

Schlagwörter:	Tuberculosis Household contact investigation Lay health workers COM-B model Behavior Change Wheel framework Implementation science

Anmerkung:	© The Author(s). 2017

Übergeordnetes Werk:	Enthalten in: Implementation science - London : BioMed Central, 2006, 12(2017), 1 vom: 09. März
Übergeordnetes Werk:	volume:12 ; year:2017 ; number:1 ; day:09 ; month:03

Links:	Volltext

DOI / URN:	10.1186/s13012-017-0561-4

Katalog-ID:	SPR02958034X

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520			\|a Background The World Health Organization recommends routine household tuberculosis contact investigation in high-burden countries but adoption has been limited. We sought to identify barriers to and facilitators of TB contact investigation during its introduction in Kampala, Uganda. Methods We collected cross-sectional qualitative data through focus group discussions and interviews with stakeholders, addressing three core activities of contact investigation: arranging household screening visits through index TB patients, visiting households to screen contacts and refer them to clinics, and evaluating at-risk contacts coming to clinics. We analyzed the data using a validated theory of behavior change, the Capability, Opportunity, and Motivation determine Behavior (COM-B) model, and sought to identify targeted interventions using the related Behavior Change Wheel implementation framework. Results We led seven focus-group discussions with 61 health-care workers, two with 21 lay health workers (LHWs), and one with four household contacts of newly diagnosed TB patients. We, in addition, performed 32 interviews with household contacts from 14 households of newly diagnosed TB patients. Commonly noted barriers included stigma, limited knowledge about TB among contacts, insufficient time and space in clinics for counselling, mistrust of health-center staff among index patients and contacts, and high travel costs for LHWs and contacts. The most important facilitators identified were the personalized and enabling services provided by LHWs. We identified education, persuasion, enablement, modeling of health-positive behaviors, incentivization, and restructuring of the service environment as relevant intervention functions with potential to alleviate barriers to and enhance facilitators of TB contact investigation. Conclusions The use of a behavioral theory and a validated implementation framework provided a comprehensive approach for systematically identifying barriers to and facilitators of TB contact investigation. The behavioral determinants identified here may be useful in tailoring interventions to improve implementation of contact investigation in Kampala and other similar urban settings.
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allfields	10.1186/s13012-017-0561-4 doi (DE-627)SPR02958034X (SPR)s13012-017-0561-4-e DE-627 ger DE-627 rakwb eng Ayakaka, Irene verfasserin aut Identifying barriers to and facilitators of tuberculosis contact investigation in Kampala, Uganda: a behavioral approach 2017 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © The Author(s). 2017 Background The World Health Organization recommends routine household tuberculosis contact investigation in high-burden countries but adoption has been limited. We sought to identify barriers to and facilitators of TB contact investigation during its introduction in Kampala, Uganda. Methods We collected cross-sectional qualitative data through focus group discussions and interviews with stakeholders, addressing three core activities of contact investigation: arranging household screening visits through index TB patients, visiting households to screen contacts and refer them to clinics, and evaluating at-risk contacts coming to clinics. We analyzed the data using a validated theory of behavior change, the Capability, Opportunity, and Motivation determine Behavior (COM-B) model, and sought to identify targeted interventions using the related Behavior Change Wheel implementation framework. Results We led seven focus-group discussions with 61 health-care workers, two with 21 lay health workers (LHWs), and one with four household contacts of newly diagnosed TB patients. We, in addition, performed 32 interviews with household contacts from 14 households of newly diagnosed TB patients. Commonly noted barriers included stigma, limited knowledge about TB among contacts, insufficient time and space in clinics for counselling, mistrust of health-center staff among index patients and contacts, and high travel costs for LHWs and contacts. The most important facilitators identified were the personalized and enabling services provided by LHWs. We identified education, persuasion, enablement, modeling of health-positive behaviors, incentivization, and restructuring of the service environment as relevant intervention functions with potential to alleviate barriers to and enhance facilitators of TB contact investigation. Conclusions The use of a behavioral theory and a validated implementation framework provided a comprehensive approach for systematically identifying barriers to and facilitators of TB contact investigation. The behavioral determinants identified here may be useful in tailoring interventions to improve implementation of contact investigation in Kampala and other similar urban settings. Tuberculosis (dpeaa)DE-He213 Household contact investigation (dpeaa)DE-He213 Lay health workers (dpeaa)DE-He213 COM-B model (dpeaa)DE-He213 Behavior Change Wheel framework (dpeaa)DE-He213 Implementation science (dpeaa)DE-He213 Ackerman, Sara aut Ggita, Joseph M. aut Kajubi, Phoebe aut Dowdy, David aut Haberer, Jessica E. aut Fair, Elizabeth aut Hopewell, Philip aut Handley, Margaret A. aut Cattamanchi, Adithya aut Katamba, Achilles aut Davis, J. Lucian aut Enthalten in Implementation science London : BioMed Central, 2006 12(2017), 1 vom: 09. März (DE-627)509006191 (DE-600)2225822-X 1748-5908 nnns volume:12 year:2017 number:1 day:09 month:03 https://dx.doi.org/10.1186/s13012-017-0561-4 kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2003 GBV_ILN_2005 GBV_ILN_2009 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2055 GBV_ILN_2111 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 12 2017 1 09 03
spelling	10.1186/s13012-017-0561-4 doi (DE-627)SPR02958034X (SPR)s13012-017-0561-4-e DE-627 ger DE-627 rakwb eng Ayakaka, Irene verfasserin aut Identifying barriers to and facilitators of tuberculosis contact investigation in Kampala, Uganda: a behavioral approach 2017 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © The Author(s). 2017 Background The World Health Organization recommends routine household tuberculosis contact investigation in high-burden countries but adoption has been limited. We sought to identify barriers to and facilitators of TB contact investigation during its introduction in Kampala, Uganda. Methods We collected cross-sectional qualitative data through focus group discussions and interviews with stakeholders, addressing three core activities of contact investigation: arranging household screening visits through index TB patients, visiting households to screen contacts and refer them to clinics, and evaluating at-risk contacts coming to clinics. We analyzed the data using a validated theory of behavior change, the Capability, Opportunity, and Motivation determine Behavior (COM-B) model, and sought to identify targeted interventions using the related Behavior Change Wheel implementation framework. Results We led seven focus-group discussions with 61 health-care workers, two with 21 lay health workers (LHWs), and one with four household contacts of newly diagnosed TB patients. We, in addition, performed 32 interviews with household contacts from 14 households of newly diagnosed TB patients. Commonly noted barriers included stigma, limited knowledge about TB among contacts, insufficient time and space in clinics for counselling, mistrust of health-center staff among index patients and contacts, and high travel costs for LHWs and contacts. The most important facilitators identified were the personalized and enabling services provided by LHWs. We identified education, persuasion, enablement, modeling of health-positive behaviors, incentivization, and restructuring of the service environment as relevant intervention functions with potential to alleviate barriers to and enhance facilitators of TB contact investigation. Conclusions The use of a behavioral theory and a validated implementation framework provided a comprehensive approach for systematically identifying barriers to and facilitators of TB contact investigation. The behavioral determinants identified here may be useful in tailoring interventions to improve implementation of contact investigation in Kampala and other similar urban settings. Tuberculosis (dpeaa)DE-He213 Household contact investigation (dpeaa)DE-He213 Lay health workers (dpeaa)DE-He213 COM-B model (dpeaa)DE-He213 Behavior Change Wheel framework (dpeaa)DE-He213 Implementation science (dpeaa)DE-He213 Ackerman, Sara aut Ggita, Joseph M. aut Kajubi, Phoebe aut Dowdy, David aut Haberer, Jessica E. aut Fair, Elizabeth aut Hopewell, Philip aut Handley, Margaret A. aut Cattamanchi, Adithya aut Katamba, Achilles aut Davis, J. Lucian aut Enthalten in Implementation science London : BioMed Central, 2006 12(2017), 1 vom: 09. März (DE-627)509006191 (DE-600)2225822-X 1748-5908 nnns volume:12 year:2017 number:1 day:09 month:03 https://dx.doi.org/10.1186/s13012-017-0561-4 kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2003 GBV_ILN_2005 GBV_ILN_2009 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2055 GBV_ILN_2111 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 12 2017 1 09 03
allfields_unstemmed	10.1186/s13012-017-0561-4 doi (DE-627)SPR02958034X (SPR)s13012-017-0561-4-e DE-627 ger DE-627 rakwb eng Ayakaka, Irene verfasserin aut Identifying barriers to and facilitators of tuberculosis contact investigation in Kampala, Uganda: a behavioral approach 2017 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © The Author(s). 2017 Background The World Health Organization recommends routine household tuberculosis contact investigation in high-burden countries but adoption has been limited. We sought to identify barriers to and facilitators of TB contact investigation during its introduction in Kampala, Uganda. Methods We collected cross-sectional qualitative data through focus group discussions and interviews with stakeholders, addressing three core activities of contact investigation: arranging household screening visits through index TB patients, visiting households to screen contacts and refer them to clinics, and evaluating at-risk contacts coming to clinics. We analyzed the data using a validated theory of behavior change, the Capability, Opportunity, and Motivation determine Behavior (COM-B) model, and sought to identify targeted interventions using the related Behavior Change Wheel implementation framework. Results We led seven focus-group discussions with 61 health-care workers, two with 21 lay health workers (LHWs), and one with four household contacts of newly diagnosed TB patients. We, in addition, performed 32 interviews with household contacts from 14 households of newly diagnosed TB patients. Commonly noted barriers included stigma, limited knowledge about TB among contacts, insufficient time and space in clinics for counselling, mistrust of health-center staff among index patients and contacts, and high travel costs for LHWs and contacts. The most important facilitators identified were the personalized and enabling services provided by LHWs. We identified education, persuasion, enablement, modeling of health-positive behaviors, incentivization, and restructuring of the service environment as relevant intervention functions with potential to alleviate barriers to and enhance facilitators of TB contact investigation. Conclusions The use of a behavioral theory and a validated implementation framework provided a comprehensive approach for systematically identifying barriers to and facilitators of TB contact investigation. The behavioral determinants identified here may be useful in tailoring interventions to improve implementation of contact investigation in Kampala and other similar urban settings. Tuberculosis (dpeaa)DE-He213 Household contact investigation (dpeaa)DE-He213 Lay health workers (dpeaa)DE-He213 COM-B model (dpeaa)DE-He213 Behavior Change Wheel framework (dpeaa)DE-He213 Implementation science (dpeaa)DE-He213 Ackerman, Sara aut Ggita, Joseph M. aut Kajubi, Phoebe aut Dowdy, David aut Haberer, Jessica E. aut Fair, Elizabeth aut Hopewell, Philip aut Handley, Margaret A. aut Cattamanchi, Adithya aut Katamba, Achilles aut Davis, J. Lucian aut Enthalten in Implementation science London : BioMed Central, 2006 12(2017), 1 vom: 09. März (DE-627)509006191 (DE-600)2225822-X 1748-5908 nnns volume:12 year:2017 number:1 day:09 month:03 https://dx.doi.org/10.1186/s13012-017-0561-4 kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2003 GBV_ILN_2005 GBV_ILN_2009 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2055 GBV_ILN_2111 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 12 2017 1 09 03
allfieldsGer	10.1186/s13012-017-0561-4 doi (DE-627)SPR02958034X (SPR)s13012-017-0561-4-e DE-627 ger DE-627 rakwb eng Ayakaka, Irene verfasserin aut Identifying barriers to and facilitators of tuberculosis contact investigation in Kampala, Uganda: a behavioral approach 2017 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © The Author(s). 2017 Background The World Health Organization recommends routine household tuberculosis contact investigation in high-burden countries but adoption has been limited. We sought to identify barriers to and facilitators of TB contact investigation during its introduction in Kampala, Uganda. Methods We collected cross-sectional qualitative data through focus group discussions and interviews with stakeholders, addressing three core activities of contact investigation: arranging household screening visits through index TB patients, visiting households to screen contacts and refer them to clinics, and evaluating at-risk contacts coming to clinics. We analyzed the data using a validated theory of behavior change, the Capability, Opportunity, and Motivation determine Behavior (COM-B) model, and sought to identify targeted interventions using the related Behavior Change Wheel implementation framework. Results We led seven focus-group discussions with 61 health-care workers, two with 21 lay health workers (LHWs), and one with four household contacts of newly diagnosed TB patients. We, in addition, performed 32 interviews with household contacts from 14 households of newly diagnosed TB patients. Commonly noted barriers included stigma, limited knowledge about TB among contacts, insufficient time and space in clinics for counselling, mistrust of health-center staff among index patients and contacts, and high travel costs for LHWs and contacts. The most important facilitators identified were the personalized and enabling services provided by LHWs. We identified education, persuasion, enablement, modeling of health-positive behaviors, incentivization, and restructuring of the service environment as relevant intervention functions with potential to alleviate barriers to and enhance facilitators of TB contact investigation. Conclusions The use of a behavioral theory and a validated implementation framework provided a comprehensive approach for systematically identifying barriers to and facilitators of TB contact investigation. The behavioral determinants identified here may be useful in tailoring interventions to improve implementation of contact investigation in Kampala and other similar urban settings. Tuberculosis (dpeaa)DE-He213 Household contact investigation (dpeaa)DE-He213 Lay health workers (dpeaa)DE-He213 COM-B model (dpeaa)DE-He213 Behavior Change Wheel framework (dpeaa)DE-He213 Implementation science (dpeaa)DE-He213 Ackerman, Sara aut Ggita, Joseph M. aut Kajubi, Phoebe aut Dowdy, David aut Haberer, Jessica E. aut Fair, Elizabeth aut Hopewell, Philip aut Handley, Margaret A. aut Cattamanchi, Adithya aut Katamba, Achilles aut Davis, J. Lucian aut Enthalten in Implementation science London : BioMed Central, 2006 12(2017), 1 vom: 09. März (DE-627)509006191 (DE-600)2225822-X 1748-5908 nnns volume:12 year:2017 number:1 day:09 month:03 https://dx.doi.org/10.1186/s13012-017-0561-4 kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2003 GBV_ILN_2005 GBV_ILN_2009 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2055 GBV_ILN_2111 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 12 2017 1 09 03
allfieldsSound	10.1186/s13012-017-0561-4 doi (DE-627)SPR02958034X (SPR)s13012-017-0561-4-e DE-627 ger DE-627 rakwb eng Ayakaka, Irene verfasserin aut Identifying barriers to and facilitators of tuberculosis contact investigation in Kampala, Uganda: a behavioral approach 2017 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © The Author(s). 2017 Background The World Health Organization recommends routine household tuberculosis contact investigation in high-burden countries but adoption has been limited. We sought to identify barriers to and facilitators of TB contact investigation during its introduction in Kampala, Uganda. Methods We collected cross-sectional qualitative data through focus group discussions and interviews with stakeholders, addressing three core activities of contact investigation: arranging household screening visits through index TB patients, visiting households to screen contacts and refer them to clinics, and evaluating at-risk contacts coming to clinics. We analyzed the data using a validated theory of behavior change, the Capability, Opportunity, and Motivation determine Behavior (COM-B) model, and sought to identify targeted interventions using the related Behavior Change Wheel implementation framework. Results We led seven focus-group discussions with 61 health-care workers, two with 21 lay health workers (LHWs), and one with four household contacts of newly diagnosed TB patients. We, in addition, performed 32 interviews with household contacts from 14 households of newly diagnosed TB patients. Commonly noted barriers included stigma, limited knowledge about TB among contacts, insufficient time and space in clinics for counselling, mistrust of health-center staff among index patients and contacts, and high travel costs for LHWs and contacts. The most important facilitators identified were the personalized and enabling services provided by LHWs. We identified education, persuasion, enablement, modeling of health-positive behaviors, incentivization, and restructuring of the service environment as relevant intervention functions with potential to alleviate barriers to and enhance facilitators of TB contact investigation. Conclusions The use of a behavioral theory and a validated implementation framework provided a comprehensive approach for systematically identifying barriers to and facilitators of TB contact investigation. The behavioral determinants identified here may be useful in tailoring interventions to improve implementation of contact investigation in Kampala and other similar urban settings. Tuberculosis (dpeaa)DE-He213 Household contact investigation (dpeaa)DE-He213 Lay health workers (dpeaa)DE-He213 COM-B model (dpeaa)DE-He213 Behavior Change Wheel framework (dpeaa)DE-He213 Implementation science (dpeaa)DE-He213 Ackerman, Sara aut Ggita, Joseph M. aut Kajubi, Phoebe aut Dowdy, David aut Haberer, Jessica E. aut Fair, Elizabeth aut Hopewell, Philip aut Handley, Margaret A. aut Cattamanchi, Adithya aut Katamba, Achilles aut Davis, J. Lucian aut Enthalten in Implementation science London : BioMed Central, 2006 12(2017), 1 vom: 09. März (DE-627)509006191 (DE-600)2225822-X 1748-5908 nnns volume:12 year:2017 number:1 day:09 month:03 https://dx.doi.org/10.1186/s13012-017-0561-4 kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2003 GBV_ILN_2005 GBV_ILN_2009 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2055 GBV_ILN_2111 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 12 2017 1 09 03
language	English
source	Enthalten in Implementation science 12(2017), 1 vom: 09. März volume:12 year:2017 number:1 day:09 month:03
sourceStr	Enthalten in Implementation science 12(2017), 1 vom: 09. März volume:12 year:2017 number:1 day:09 month:03
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institution	findex.gbv.de
topic_facet	Tuberculosis Household contact investigation Lay health workers COM-B model Behavior Change Wheel framework Implementation science
isfreeaccess_bool	true
container_title	Implementation science
authorswithroles_txt_mv	Ayakaka, Irene @@aut@@ Ackerman, Sara @@aut@@ Ggita, Joseph M. @@aut@@ Kajubi, Phoebe @@aut@@ Dowdy, David @@aut@@ Haberer, Jessica E. @@aut@@ Fair, Elizabeth @@aut@@ Hopewell, Philip @@aut@@ Handley, Margaret A. @@aut@@ Cattamanchi, Adithya @@aut@@ Katamba, Achilles @@aut@@ Davis, J. Lucian @@aut@@
publishDateDaySort_date	2017-03-09T00:00:00Z
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author	Ayakaka, Irene
spellingShingle	Ayakaka, Irene misc Tuberculosis misc Household contact investigation misc Lay health workers misc COM-B model misc Behavior Change Wheel framework misc Implementation science Identifying barriers to and facilitators of tuberculosis contact investigation in Kampala, Uganda: a behavioral approach
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topic_title	Identifying barriers to and facilitators of tuberculosis contact investigation in Kampala, Uganda: a behavioral approach Tuberculosis (dpeaa)DE-He213 Household contact investigation (dpeaa)DE-He213 Lay health workers (dpeaa)DE-He213 COM-B model (dpeaa)DE-He213 Behavior Change Wheel framework (dpeaa)DE-He213 Implementation science (dpeaa)DE-He213
topic	misc Tuberculosis misc Household contact investigation misc Lay health workers misc COM-B model misc Behavior Change Wheel framework misc Implementation science
topic_unstemmed	misc Tuberculosis misc Household contact investigation misc Lay health workers misc COM-B model misc Behavior Change Wheel framework misc Implementation science
topic_browse	misc Tuberculosis misc Household contact investigation misc Lay health workers misc COM-B model misc Behavior Change Wheel framework misc Implementation science
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title	Identifying barriers to and facilitators of tuberculosis contact investigation in Kampala, Uganda: a behavioral approach
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title_full	Identifying barriers to and facilitators of tuberculosis contact investigation in Kampala, Uganda: a behavioral approach
author_sort	Ayakaka, Irene
journal	Implementation science
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author_browse	Ayakaka, Irene Ackerman, Sara Ggita, Joseph M. Kajubi, Phoebe Dowdy, David Haberer, Jessica E. Fair, Elizabeth Hopewell, Philip Handley, Margaret A. Cattamanchi, Adithya Katamba, Achilles Davis, J. Lucian
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author-letter	Ayakaka, Irene
doi_str_mv	10.1186/s13012-017-0561-4
title_sort	identifying barriers to and facilitators of tuberculosis contact investigation in kampala, uganda: a behavioral approach
title_auth	Identifying barriers to and facilitators of tuberculosis contact investigation in Kampala, Uganda: a behavioral approach
abstract	Background The World Health Organization recommends routine household tuberculosis contact investigation in high-burden countries but adoption has been limited. We sought to identify barriers to and facilitators of TB contact investigation during its introduction in Kampala, Uganda. Methods We collected cross-sectional qualitative data through focus group discussions and interviews with stakeholders, addressing three core activities of contact investigation: arranging household screening visits through index TB patients, visiting households to screen contacts and refer them to clinics, and evaluating at-risk contacts coming to clinics. We analyzed the data using a validated theory of behavior change, the Capability, Opportunity, and Motivation determine Behavior (COM-B) model, and sought to identify targeted interventions using the related Behavior Change Wheel implementation framework. Results We led seven focus-group discussions with 61 health-care workers, two with 21 lay health workers (LHWs), and one with four household contacts of newly diagnosed TB patients. We, in addition, performed 32 interviews with household contacts from 14 households of newly diagnosed TB patients. Commonly noted barriers included stigma, limited knowledge about TB among contacts, insufficient time and space in clinics for counselling, mistrust of health-center staff among index patients and contacts, and high travel costs for LHWs and contacts. The most important facilitators identified were the personalized and enabling services provided by LHWs. We identified education, persuasion, enablement, modeling of health-positive behaviors, incentivization, and restructuring of the service environment as relevant intervention functions with potential to alleviate barriers to and enhance facilitators of TB contact investigation. Conclusions The use of a behavioral theory and a validated implementation framework provided a comprehensive approach for systematically identifying barriers to and facilitators of TB contact investigation. The behavioral determinants identified here may be useful in tailoring interventions to improve implementation of contact investigation in Kampala and other similar urban settings. © The Author(s). 2017
abstractGer	Background The World Health Organization recommends routine household tuberculosis contact investigation in high-burden countries but adoption has been limited. We sought to identify barriers to and facilitators of TB contact investigation during its introduction in Kampala, Uganda. Methods We collected cross-sectional qualitative data through focus group discussions and interviews with stakeholders, addressing three core activities of contact investigation: arranging household screening visits through index TB patients, visiting households to screen contacts and refer them to clinics, and evaluating at-risk contacts coming to clinics. We analyzed the data using a validated theory of behavior change, the Capability, Opportunity, and Motivation determine Behavior (COM-B) model, and sought to identify targeted interventions using the related Behavior Change Wheel implementation framework. Results We led seven focus-group discussions with 61 health-care workers, two with 21 lay health workers (LHWs), and one with four household contacts of newly diagnosed TB patients. We, in addition, performed 32 interviews with household contacts from 14 households of newly diagnosed TB patients. Commonly noted barriers included stigma, limited knowledge about TB among contacts, insufficient time and space in clinics for counselling, mistrust of health-center staff among index patients and contacts, and high travel costs for LHWs and contacts. The most important facilitators identified were the personalized and enabling services provided by LHWs. We identified education, persuasion, enablement, modeling of health-positive behaviors, incentivization, and restructuring of the service environment as relevant intervention functions with potential to alleviate barriers to and enhance facilitators of TB contact investigation. Conclusions The use of a behavioral theory and a validated implementation framework provided a comprehensive approach for systematically identifying barriers to and facilitators of TB contact investigation. The behavioral determinants identified here may be useful in tailoring interventions to improve implementation of contact investigation in Kampala and other similar urban settings. © The Author(s). 2017
abstract_unstemmed	Background The World Health Organization recommends routine household tuberculosis contact investigation in high-burden countries but adoption has been limited. We sought to identify barriers to and facilitators of TB contact investigation during its introduction in Kampala, Uganda. Methods We collected cross-sectional qualitative data through focus group discussions and interviews with stakeholders, addressing three core activities of contact investigation: arranging household screening visits through index TB patients, visiting households to screen contacts and refer them to clinics, and evaluating at-risk contacts coming to clinics. We analyzed the data using a validated theory of behavior change, the Capability, Opportunity, and Motivation determine Behavior (COM-B) model, and sought to identify targeted interventions using the related Behavior Change Wheel implementation framework. Results We led seven focus-group discussions with 61 health-care workers, two with 21 lay health workers (LHWs), and one with four household contacts of newly diagnosed TB patients. We, in addition, performed 32 interviews with household contacts from 14 households of newly diagnosed TB patients. Commonly noted barriers included stigma, limited knowledge about TB among contacts, insufficient time and space in clinics for counselling, mistrust of health-center staff among index patients and contacts, and high travel costs for LHWs and contacts. The most important facilitators identified were the personalized and enabling services provided by LHWs. We identified education, persuasion, enablement, modeling of health-positive behaviors, incentivization, and restructuring of the service environment as relevant intervention functions with potential to alleviate barriers to and enhance facilitators of TB contact investigation. Conclusions The use of a behavioral theory and a validated implementation framework provided a comprehensive approach for systematically identifying barriers to and facilitators of TB contact investigation. The behavioral determinants identified here may be useful in tailoring interventions to improve implementation of contact investigation in Kampala and other similar urban settings. © The Author(s). 2017
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title_short	Identifying barriers to and facilitators of tuberculosis contact investigation in Kampala, Uganda: a behavioral approach
url	https://dx.doi.org/10.1186/s13012-017-0561-4
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author2	Ackerman, Sara Ggita, Joseph M. Kajubi, Phoebe Dowdy, David Haberer, Jessica E. Fair, Elizabeth Hopewell, Philip Handley, Margaret A. Cattamanchi, Adithya Katamba, Achilles Davis, J. Lucian
author2Str	Ackerman, Sara Ggita, Joseph M. Kajubi, Phoebe Dowdy, David Haberer, Jessica E. Fair, Elizabeth Hopewell, Philip Handley, Margaret A. Cattamanchi, Adithya Katamba, Achilles Davis, J. Lucian
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