Table 3 Categories divided by framework level and specified as facilitator/barrier, and “how-to” examples

Innovation

1

Access to healthcare through ACF

x

IMPACT TB increased access to healthcare through ACF

2

Early detection of TB

x

IMPACT TB facilitated early detection through ACF

3

Economic benefits

x

Economic benefits (e.g. through early diagnosis or by saving travel costs) helped increase participation in ACF

4

Free testing and treatment

x

Free testing and treatment motivated participation in ACF

5

Support for people with TB

x

Community health workers provided support, e.g. by being caring, providing counselling and conducting follow-ups

Individual professional

1

Dedication and motivation

x

x

Community health workers encouraged ACF participation, showed persistence and strong willingness to help others

2

Experience and skills

x

x

Community health workers used communication, persuasion and interpersonal skills; community health workers were familiar with the local context

3

Having a network that facilitates ACF

x

Community health workers used their networks, reputation and relationships (e.g. from working as teachers or social workers) to find their way around in communities and to approach people with presumed TB

Patient

1

Appreciation of ACF

x

Appreciation of ACF (e.g. for the benefits listed under “Innovation” above) motivated participation in ACF

2

Willingness to participate in ACF

x

x

Community health workers used their experience and skills (see “Experience and skills” above) to convince people to participate in ACF

3

Stigma and discrimination

x

Community health workers took sputum samples privately, e.g. in people’s homes, maintained confidentiality of people with TB and educated people and communities about the disease

4

Trust and mistrust

x

x

Community health workers applied experience and skills (see “Experience and skills” above) to gain trust

Social context

1

Alcohol misuse

x

Community health workers advised people against alcohol misuse

2

Community support

x

Community health workers involved members of the community to identify people with presumed TB and/or to convince a person with presumed TB to participate in ACF; community health workers asked community leaders for support in identifying people with presumed TB; community members informed each other about the possibility to participate in ACF; family members provided direct support to people with TB

3

Knowledge and awareness about TB

x

Community health workers spread knowledge and awareness about TB among persons with presumed TB and communities; suggestions were made to further increase knowledge and awareness about TB, e.g. in schools, via radio, television, or through gatherings and street drama

4

Poverty

x

Suggestions were made to provide food and/or cash transfers to people with TB

Organizational context

1

Collaboration with other stakeholders

x

x

Community health workers helped laboratory personnel in preparing slides when needed; community health workers informed public health office, village elders and politicians about ACF; suggestions were made improve collaboration with public health offices and government services

2

Distance, weather conditions and transportation

x

Community health workers gave each other confidence to overcome distances; IMPACT TB provided transportation to support community health workers where possible; suggestions were made to provide equipment such as umbrellas, raincoats, torches, shoes, boxes for sputum transportation, mobile phones as well as lunch

3

High workload

x

District Program Coordinators provided support to community health workers; community health workers took over laboratory tasks when needed; community health workers who are engaged in different projects (such as Female Community Health Volunteers) integrated their tasks, e.g. when going to a community they did not only conduct ACF, but did check-ups for pregnant women; suggestions were made to hire additional staff, e.g. to provide patient support

4

Incentives for community health workers

x

x

IMPACT TB provided monetary incentives for ACF including travel costs; suggestions were made to increase monetary incentives

5

Team support

x

x

Mutual support existed between Community Mobilizers, volunteers and laboratory staff; District Program Coordinators provided support to community health workers, e.g. though motivational talks

6

Training

x

x

IMPACT TB included training for community health workers; suggestions were made to provide more training on TB