Facilitators for and Barriers to the Implementation of National Tuberculosis Management Guidelines
DOI:
https://doi.org/10.25159/2520-5293/2862Keywords:
barriers, facilitators, implementation, National Tuberculosis Management Guidelines, Normalization Process Model, perception, primary healthcare nurse, TB management, tuberculosisAbstract
The South African government developed the National Tuberculosis Management Guidelines (NTBMGs) to provide guidance to professional healthcare workers on the management of people with TB and also those co-infected with HIV. However, little is known about primary healthcare (PHC) nurses’ perceptions of the implementation of the NTBMGs, despite their critical role in TB management. The purpose of this study was to explore PHC nurses’ perception of the implementation of the NTBMGs in order to identify factors influencing the implementation of the NTBMGs and to make recommendations to improve the implementation of the NTBMGs. The study was conducted in the Eastern Cape, South Africa. The Normalization Process Model (NPM) was used as a theoretical framework to understand the factors influencing the implementation of the NTBMGs. A qualitative, explorative, descriptive and contextual research design was utilised. Data were collected using individual semi-structured interviews on a purposive sample of 10 PHC nurses working in rural clinics. Data were analysed following a descriptive method of Tesch. The study revealed several facilitators for and barriers to the implementation of the NTBMGs based on the NPM. The facilitators included the PHC nurses’ satisfaction with the Directly Observed Treatment, Short Course (DOTS) strategy in rendering health services to TB patients, the PHC nurses’ perception of TB meetings as an appropriate platform for problem-solving, of the NTBMGs to be consistent with TB management, and of job satisfaction in relation to patient improvement. The barriers included poverty, inadequate training, shortage of staff, and a lack of material resources, a proper infection control policy, and space. There is a need for the provision of adequate human, material and infrastructural resources in order to eliminate the barriers to the implementation of the NTBMGs.
References
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Bock, N. N., P. A. Jensen, B. Miller, and E. Nardell. 2007. “Tuberculosis Infection Control in Resource-limited Settings in the Era of Expanding HIV Care and Treatment.†Journal of Infectious Diseases 196 (1 Suppl 1): S108–S113. https://doi.org/10.1086/518661
Burns N., and S. K. Grove. 2009. The Practice of Nursing Research: Conduct, Critique and Utilisation. St Louis: Elsevier.
Carlsson, M., S. Johansson, R. P. B. Eale, and B. B. Kaboru. 2014. “Nurses’ Roles and Experiences with Enhancing Adherence to Tuberculosis Treatment among Patients in Burundi: A Qualitative Study.†Tuberculosis Research and Treatment. https://doi.org/10.1155/2014/984218
Churchyard, G. J., L. D. Mametja, L. Mvusi, N. Ndjeka, A. C. Hesseling, A. Reid, S. Babatunde, and Y. Pillay. 2014. “Tuberculosis Control in South Africa: Successes, Challenges and Recommendations.†South African Medical Journal 104 (3 Suppl 1): 244–248. https://doi.org/10.7196/SAMJ.7689
Creswell, J. W. 2009. The Practice of Nursing Research. 6th ed. St Louis: Elsevier.
Day, C., and A. Gray. 2010. “Health and Related Indicators.†South African Health Review 211–364.
Department of Health. 2007. Tuberculosis strategic plan for South Africa. 2007–2011. http://www.inf.gov.za/gazette/otherdocs/2007/ (accessed 4 June 2007).
Department of Health. 2010. Strategic plan for South Africa. Pretoria: Department of Health.
Department of Health. 2014. National Tuberculosis Management Guidelines. Pretoria: Department of Health.
Department of Health and South African National Aids Council. 2017. Let Our Actions Count. Reflections on NSP 2012–2016 and Moving Forward to NSP 2017–2022. Pretoria: Department of Health and South African National Aids Council.
Eastern Cape Department of Health. 2003. Province of the Eastern Cape Department of Health. Strategic Plan 2003/4. Bisho: Eastern Cape Department of Health.
Eastern Cape Department of Health. 2016. Annual Performance Plan 2016/17–2018/19. Bisho: Eastern Cape Department of Health.
Engelbrecht, M. C., and A. J. van Rensburg. 2013. Southern African Journal of Epidemiology and Infection. https://doi.org/10.1080/10158782.2013.11441554 (accessed 15 October 2012).
Flick, U. 2009. An Introduction to Qualitative Research. 4th ed. London: Sage.
Ghebrehiwet, T. 2006. “Nurses in the Forefront of Tuberculosis Prevention, Care and Treatment.†International Nursing Review 53 (4): 239–240. https://doi.org/10.1111/j.1466-7657.2006.00531.x
Hemlata, K. N., and S. K. Saini. 2011. “A Study on Implementation of Revised National Tuberculosis Control Programme for the Community of Dadu Majra Colony, UT Chandigarh, 2010.†Nursing and Midwifery Research Journal 7 (1): 34–52.
Janse van Rensburg-Bonthuyzen, E. 2005. “Staff Capacity and Resources at Nine Free State Clinics: Shortcomings in the TB Programme.†Acta Academica Supplement 1:192–220.
Kiekkas, P., H. Brokalaki, E. Manolis, A. Samios, C. Skartsani, and G. Baltopoulos. 2007. “Patient Severity as an Indicator of Nursing Workload in the Intensive Care Unit.†Nursing in Critical Care 12 (1): 34–41. https://doi.org/10.1111/j.1478-5153.2006.00193.x
Lehmann, U., and D. Sanders. 2007. Community Care Givers: What Do We Know About Them? University of the Western Cape: School of Public Health.
Leon, N., S. Lewin, and C. Mathews. 2013. “Implementing a Provider-initiated Testing and Counselling (PITC) Intervention in Cape Town, South Africa: A Process Evaluation Using the Normalisation Process Model.†Implementation Science 8 (1): 97. https://doi.org/10.1186/1748-5908-8-97
May, C. 2006. “A Rational Model for Assessing and Evaluating Complex Interventions in Health Care.†BMC Health Services Research 6 (1): 86. https://doi.org/10.1186/1472-6963-6-86
Mehtar, S. 2008. “Lowbury Lecture 2007: Infection Prevention and Control Strategies for Tuberculosis in Developing Countries – Lessons Learnt from Africa.†Journal of Hospital Infection 69 (4): 321–327. https://doi.org/10.1016/j.jhin.2008.04.015
Mudzingiri, C., E. Moyana, and F. Mbengo. 2016. “Caregivers’ Perspective of the Child Support Grant in South Africa: An Exploratory Study.†Journal of Psychology in Africa 26 (2): 10–20. https://doi.org/10.1080/14330237.2016.1163911
Muller, M., M. Bezuidenhout, and K. Jooste. 2011. Health Service Management. 2nd ed. Cape Town: Juta.
O’Donnell, M. R., J. Jarand, M. Loveday, N. Padayatchi, J. Zelnick, L. Werner, K. Naidoo, I. Master, G. Osburn, C. Kvasnovsky, K. Shean, M. Pai, M. van der Walt, C. R. Horsburgh, and K. Dheda. 2010. “High Incidence of Hospital Admissions with Multidrug-resistant and Extensively Drug-resistant Tuberculosis among South African Health Care Workers.†Annals of Internal Medicine 153 (8): 516–522. https://doi.org/10.7326/0003-4819-153-8-201010190-00008
Padayatchi, N., K. Naidoo, H. Dawood, A. B. M. Kharsany, and Q. Abdool Karim. 2010. “A Review of Progress on HIV, AIDS and Tuberculosis.†http://journals.co.za/docserver/fulltext/healthr/2010/1/healthr_2010_a13.pdf?expires=1506881440&id=id&accname=guest&checksum=04E88DED89A7ACBE1113526B50A37025 (accessed 3 October 2017).
Public Health Association of South Africa. 2014. Multi Drug Resistant Tuberculosis: Behavioural Aspects Behind Increasing Drug Resistant Cases in the Eastern Cape. https://www.phasa.org.za/multi-drug-resistant-tuberculosis-behavioural-aspects-behind-increasing-drug-resistant-cases-eastern-cape/ (accessed 3 August 2017).
Reagon, G., J. Irlam, J. Levin. 2004. National Primary Health Care Facilities Survey 2003. Durban: Health Systems Trust.
Rogers, A., S. Kirk, C. Gately, C. R. May, and T. Finch. 2011. “Established Users and the Making of Telecare Work in Long Term Condition Management: Implications for Health Policy.†Social Science and Medicine 72 (7): 1077–84. https://doi.org/10.1016/j.socscimed.2011.01.031
Sampson, H. 2004. “Navigating the Waves: The Usefulness of a Pilot in Qualitative Research.†Qualitative Research 4 (3): 383–402. https://doi.org/10.1177/1468794104047236
Scheineder, H., and P. Barron. 2008. “Achieving the Millennium Development Goals in South Africa Through the Revitalization of Primary Health Care and a Strengthened District Health System.†Position paper. Cape Town: University of Cape Town.
Sissolak, D., F. Marais, and S. Mehtar. 2011. “TB Infection Prevention and Control Experiences of South African Nurses – A Phenomenological Study.†BMC Public Health 11 (1): 262. https://doi.org/10.1186/1471-2458-11-262
Soul City Institute of Health and Development Communication and Department of Health. 2015. Literature Review of TB in South Africa. Pretoria: Soul City Institute of Health and Development Communication and Department of Health.
South Africa. 1993. The Occupational Health and Safety Act (Act No. 85 of 1993). Pretoria: Government Printer.
South Africa. 1996. The Constitution of the Republic of South Africa (Act No. 108 of 1996). Pretoria: Government Printer.
South Africa. 2003. The National Health Act (Act No. 61 of 2003). Pretoria: Government Printer.
Statistics South Africa. 2014. Mortality and Causes of Death in South Africa, 2014: Findings from Death Notification. Pretoria. Statistics South Africa.
Statistics South Africa. 2015. Mid-year Population Estimates. Pretoria. Statistics South Africa.
Terre Blanche, M, K. Durrheim, and D. Painter. 2007. Research in Practice. Cape Town: University of Cape Town Press.
Tlale, L. B., M. Molefi, T. Masupe, O. Kgosiesele, J. Tshikuka, and A. P. Steenhoff. 2015. “Knowledge and Perception of Health Care Workers Towards National Tuberculosis Contact Tracing Policy and Guidelines in a Rural District.†Journal of International Medical Research 2 (3): 10–15.
Trost, J. 2010. Kvalitativa Intervjuer. [Qualitative Interviews] Lund: Studentliteratur.
White, Z. N. 2011. “Survey on the Knowledge, Attitudes and Practices on Tuberculosis (TB) Among Health Care Workers in Kingston and St. Andrew, Jamaica.†Master’s Dissertation, University of Liverpool.
World Health Organization. 2009. Global Tuberculosis Control 2009 – Epidemiology Strategy Financing. Geneva: World Health Organization.
World Health Organization. 2013. Global Tuberculosis Report 2013. Geneva: World Health Organization.
World Health Organization. 2014. Global Tuberculosis Control Report 2014. Geneva: World Health Organization.
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Published
2018-01-12
How to Cite
Dlwati, Lucretia V, Thandisizwe R Mavundla, and Fungai Mbengo. 2018. “Facilitators for and Barriers to the Implementation of National Tuberculosis Management Guidelines”. Africa Journal of Nursing and Midwifery 19 (3):20 pages. https://doi.org/10.25159/2520-5293/2862.
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