Theory-Informed Interventions to Improve the Quality of Tuberculosis Evaluation at Ugandan Health Centers: A Quasi- Experimental Study
Date
2015
Authors
Chaisson, Lelia H.
Katamba, Achilles
Haguma, Priscilla
Ochom, Emmanuel
Ayakaka, Irene
Mugabe, Frank
Miller, Cecily
Vittinghoff, Eric
Davis, J. Lucian
Handley, Margaret A.
Journal Title
Journal ISSN
Volume Title
Publisher
PLoS ONE
Abstract
Tuberculosis (TB) remains under-diagnosed in many countries, in part due to poor evaluation
practices at health facilities. Theory-informed strategies are needed to improve implementation
of TB evaluation guidelines. We aimed to evaluate the impact of performance
feedback and same-day smear microscopy on the quality of TB evaluation at 6 health centers
in rural Uganda.
Methods
We tested components of a multi-faceted intervention to improve adherence to the International
Standards for Tuberculosis Care(ISTC): performance feedback and same-day smear
microscopy. The strategies were selected based on a qualitative assessment guided by the
Theory of Planned Behavior and the PRECEDE model. We collected patient data 6 months
before and after the introduction of each intervention component, and compared ISTC adherence
in the pre- and post-intervention periods for adults with cough 2 weeks’ duration.
Results
The performance feedback evaluation included 1,446 adults; 838 (58%) were evaluated
during the pre-intervention period and 608 (42%) during the post-intervention period. Performance
feedback resulted in a 15% (95%CI +10%to +20%, p<0.001) increase in the proportion of patients receiving ISTC-adherent care. The same-day microscopy evaluation
included 1,950 adults; 907 (47%) were evaluated during the pre-intervention period and
1,043 (53%) during the post-intervention period. Same-day microscopy was associated
with a 14% (95%CI +10%to +18%, p<0.001) increase in the proportion of patients receiving
ISTC-adherent care.
Conclusions
Performance feedback and same-day microscopy should be considered along with ISTC
training as part of a multi-faceted intervention to improve the quality of TB evaluation in
other high TB burden countries.
Description
Keywords
Tuberculosis, Ugandan Health Centers, Quasi- Experimental Study
Citation
Chaisson LH, Katamba A, Haguma P, Ochom E, Ayakaka I, Mugabe F, et al. (2015) Theory- Informed Interventions to Improve the Quality of Tuberculosis Evaluation at Ugandan Health Centers: A Quasi-Experimental Study. PLoS ONE 10(7): e0132573. doi:10.1371/journal.pone.0132573