Tuberculosis infection control in a high drug-resistance setting in rural South Africa: Information, motivation, and behavioral skills

SummaryBackgroundTuberculosis (TB) is transmitted in resource-limited facilities where TB infection control (IC) is poorly implemented. Theory-based behavioral models can potentially improve IC practices.MethodsThe present study used an anonymous questionnaire to assess healthcare worker (HCW) TB IC information, motivation, and behavioral skills (IMB) and implementation in two resource-limited rural South African hospitals with prevalent drug-resistant TB.ResultsBetween June and August 2010, 198 surveys were completed. Although the respondents demonstrated information proficiency and positive motivation, 22.8% did not consider TB IC to be worthwhile. Most tasks were rated as easy by survey participants, but responding HCWs highlighted challenges in discrete behavioral skills. The majority of responding HCWs reported that they always wore respirators (54.3%), instructed patients on cough hygiene (63.0%), and ensured natural ventilation (67.4%) in high-risk areas. Most respondents (74.0%) knew their HIV status. Social support items correlated with the implementation of the first three aforementioned practices but not with the respondents’ knowledge of their HIV status. In most cases, motivation and behavioral skills, but not information, were associated with implementation.ConclusionHCWs in rural South African hospitals with high drug-resistance demonstrated moderate IMB and implementation of TB IC. Improvement efforts should emphasize the development of HCW motivation and behavioral skills as well as social support from colleagues and supervisors. Such interventions should be informed by baseline IMB assessments. In the present study, a trimmed/modified IMB model helped characterize TB IC implementation.

► Tuberculosis infection control (TB IC) can prevent nosocomial transmission.
► We observed moderate TB IC implementation in two rural South African hospitals.
► Healthcare worker TB IC information levels did not correlate with implementation.
► Developing healthcare worker motivation and behavioral skills could improve TB IC.
► A behavioral model helped characterize TB IC in a resource-limited setting.