Table 2 Barriers to and Facilitators for TB treatment initiation among patients diagnosed with TB at public hospitals in Uganda
Domain | BARRIERS | |
|---|---|---|
Health Facility Level | Patient-level | |
Capability | ||
 Psychological | Lack of awareness of the magnitude of pre-treatment LFU at the health facilities | Lack of TB knowledge among patients |
Opportunity | ||
 Physical | Insufficient time and space for patient education | Long turnaround time for sputum results |
Late delivery of sputum samples to the laboratory due to batched sample collection. | Â | |
Lack of tools to monitor TB treatment initiation among patients diagnosed with TB | Lack of transport funds to retrieve sputum results | |
Difficulty retrieving sputum test results by most clinics due to lack of collaboration with the laboratory | Lack of time to retrieve sputum results. | |
Difficulty tracing patients due to inadequate recording of patient locators (physical addresses or phone numbers). | Conflicting messages from healthcare workers about sputum results retrieval. | |
 Social | Disinterest in performing sputum analysis. | Stigma |
Motivation | ||
 Automatic | Staff discomfort with performing sputum analysis | TB associated stigma |
 Reflective | Reduced motivation to collect sputum results due to difficulties accessing the laboratory. | Misconceptions about susceptibility to TB disease |
FACILITATORS | ||
 Capability | ||
  Psychological | Knowledge of QI improvement methods | Prior knowledge of TB |
 Opportunity | ||
  Physical | Availability of cough screeners to facilitate TB screening | Availability of sputum results on same-day as first clinic visit. |
| Â | Availability of community healthcare workers to trace patients in the community | Ease of access to TB treatment after results retrieval |
| Â | Ability to notify patients about their sputum test results through phone calls. | Â |
  Social | Health facility norms e.g. escorting patients diagnosed with TB to the TB clinics. |  |
 Motivation | ||
  Automatic |  | Desire to get well and provide for/take care of family |
| Â | Â | Desire to protect family members from TB Courage obtained after psychological counselling |
  Reflective | Healthcare workers’ sense of duty to the patients and community | Trust in quality of care at larger public health facilities. |