Table 4. Barriers to staff’s acceptance of disease screening and isoniazid preventive therapy for the child contacts of tuberculosis patients, community lung clinic, Bandung, Indonesia, 2009–2012.
| Barriers | Interview findingsa | Illustrative quotes |
|---|---|---|
| Screening | ||
| Doubts about the workability of the child contact management programme | Staff expressed doubts and frustration about the practicality of programmes because patients did not participate. They highlighted the need for better education about the importance of child contact screening. | “The challenge is in applying it. For the practitioners, it’s possible to apply it, but for the patients not every patient is willing to follow the procedure.” (nurse) “Mmm…if the parents understand that it’s very important to bring their children for tests, they will.” (doctor) |
| Doubts about the clinic’s capability | The majority of staff felt the clinic had the resources to manage child contacts well. However, several nurses mentioned an increased workload and the risk of personnel shortages. | “From our side, we’re ready. The provision of test equipment is sufficient, human resources are available.” (nurse) “Active case-finding will surely increase the numbers of patients – I don’t think we’re ready for that. To give service to 100 patients a day, we feel very overwhelmed.” (nurse) |
| Isoniazid preventive therapy | ||
| Poor staff knowledge | Staff knowledge of latent tuberculosis infection and of the diagnostic role of the tuberculin skin test was poor. They mentioned that child contacts who tested positive were given full tuberculosis therapy while those who tested negative received isoniazid preventive therapy. | “…we perform tests; if negative, then we assess the score and if it is less than 6, we give them prophylaxis for 3 months. Then, if the Mantoux test is positive and the score is more than 6, we treat them as tuberculosis patients.” (doctor) |
| Lack of compliance with treatment guidelines | Staff members noted that there was a lack of conformity regarding the provision of isoniazid preventive therapy and this negatively affected implementation. | “At the moment, I don’t [prescribe isoniazid], on the assumption that healthy people don’t need medication…” (doctor) |
| Confusion about who is responsible for prescribing | Staff members not directly involved with child care lacked knowledge or interest in child contact management despite the regular rotation of staff through all the clinics. Nurses indicated that they had a limited influence on child contact management. | “But for the practice, because I work in a clinic for adult patients, I don’t know if all children whose parents have tuberculosis are being given prevention.” (doctor) “For us nurses, we don’t have any authority, so it’s all up to the doctors.” (nurse) |
a Barriers to staff’s acceptance of disease screening and of isoniazid preventive therapy were evaluated in interviews with five doctors and five nurses.