Research article

Consensual improvement actions for the Tuberculosis Control Programme in Pernambuco state, Brazil: an e-Delphi study

  • Received: 15 February 2019 Accepted: 25 June 2019 Published: 12 July 2019
  • Objectives: Tuberculosis (TB) remains a major public health problem, particularly in low and middle-income countries. The aim of this study is to consensualise improvement actions for the Tuberculosis Control Programme of the Pernambuco state (SPTC), Brazil. Methods: Firstly, a preliminary workshop was conducted with experts (n = 8), including key stakeholders and health professionals, to select structure and process indicators pertaining to the tuberculosis control programme. Then, an e-Delphi was carried out with a purposive sample of 11 local TB experts. The first-round questionnaire was comprised of 19 open-ended questions on possible improvement actions, based on programme indicators obtained in the previous stage. In the second-round experts rated each action for relevance and feasibility, using a four-point scale. In the last round the participants rated the actions again, in the light of group’s answers. We used published criteria to define consensus at the outset of the study. Key findings: Eighty-nine improvement actions achieved a high degree of consensus in both feasibility and relevance in round three. Eighty-six actions were grouped under 19 structure and process indicators, while three were consideredcross-sectional in scope (i.e. related to more than one indicator). Ten out of the 86 actions obtained at least 70% of ratings on the highest score of the scale both for relevance and feasibility. These included: “Request and availability of sputum pots can be made by any health professional in the health unit”. Conclusions: The wide array of actions obtained in this Delphi represent a resource from which local SPTC services can select the actions most suitable for each context. The ten most relevant and feasible actions represent a particularly useful starting point to streamline change and potentially improve programme indicators.

    Citation: Simone Santos Bezerra, Mara Pereira Guerreiro, José Lamartine Soares Sobrinho. Consensual improvement actions for the Tuberculosis Control Programme in Pernambuco state, Brazil: an e-Delphi study[J]. AIMS Public Health, 2019, 6(3): 229-241. doi: 10.3934/publichealth.2019.3.229

    Related Papers:

  • Objectives: Tuberculosis (TB) remains a major public health problem, particularly in low and middle-income countries. The aim of this study is to consensualise improvement actions for the Tuberculosis Control Programme of the Pernambuco state (SPTC), Brazil. Methods: Firstly, a preliminary workshop was conducted with experts (n = 8), including key stakeholders and health professionals, to select structure and process indicators pertaining to the tuberculosis control programme. Then, an e-Delphi was carried out with a purposive sample of 11 local TB experts. The first-round questionnaire was comprised of 19 open-ended questions on possible improvement actions, based on programme indicators obtained in the previous stage. In the second-round experts rated each action for relevance and feasibility, using a four-point scale. In the last round the participants rated the actions again, in the light of group’s answers. We used published criteria to define consensus at the outset of the study. Key findings: Eighty-nine improvement actions achieved a high degree of consensus in both feasibility and relevance in round three. Eighty-six actions were grouped under 19 structure and process indicators, while three were consideredcross-sectional in scope (i.e. related to more than one indicator). Ten out of the 86 actions obtained at least 70% of ratings on the highest score of the scale both for relevance and feasibility. These included: “Request and availability of sputum pots can be made by any health professional in the health unit”. Conclusions: The wide array of actions obtained in this Delphi represent a resource from which local SPTC services can select the actions most suitable for each context. The ten most relevant and feasible actions represent a particularly useful starting point to streamline change and potentially improve programme indicators.


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    Acknowledgments



    This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.We are grateful to Unidade de Investigação e Desenvolvimento em Enfermagem (ui&de), Escola Superior de Enfermagem de Lisboa for supporting the publication of this paper.

    Ethics



    Participation in this panel could involve expressing views on the quality or performance of the SPTC. One ethical concern is the risk of connecting participants' identities to their responses. Therefore, steps were taken to ensure confidentiality. Participants were asked to provide solely general demographic information, such as age, gender, and years of professional experience. Each expert was assigned a unique identifier, which was kept in a database accessible only to the researchers. Access to data files and electronic mail was protected by passwords. We submitted the study protocol through PlataformaBrasil for ethical approval, which was granted by the Ethics Committee of the auhors' institution.

    Conflicts of interest



    All authors declare no conflicts of interest in this paper.

    [1] Munro S, Lewin S, Swart T, et al. (2007) A review of health behavior theories: how useful are these for developing interventions to promote long-term medication adherence for TB and HIV/AIDS? BMC Public Health 7: 104. doi: 10.1186/1471-2458-7-104
    [2] Silva APSC, Souza WV de, Albuquerque M de FPM, et al. (2016) Two decades of tuberculosis in a city in Northeastern Brazil: advances and challenges in time and space. Rev Soc Bras Med Trop 49: 211–221. doi: 10.1590/0037-8682-0065-2016
    [3] MagalhaesBosi ML, Uchimura KY (2016) Quality Perspectives in Tuberculosis Control Programs Evaluation. Heal Syst Policy Res 3: 20.
    [4] Macinko J, Harris MJ (2015) Brazil's Family Health Strategy-Delivering Community-Based Primary Care in a Universal Health System. N Engl J Med 372: 2177–2181. doi: 10.1056/NEJMp1501140
    [5] de Oliveira LGD, Gonçalves L, De Oliveira D, et al. (2015) Análise da implantação do Programa de Controle da Tuberculose em unidades prisionais no Brasil. Cad Saúde Pública 31: 543–554. doi: 10.1590/0102-311x00042914
    [6] Silva PF, Moura GS, Caldas AJM, et al. (2014) Fatores associados ao abandono do tratamento da tuberculose pulmonar no Maranhão, Brasil, no período de 2001 a 2010. Cad Saúde Pública 30: 1745–1754. doi: 10.1590/0102-311X00124513
    [7] Brasil (2014) Panorama da Tuberculose no Brasil: indicadores epidemiológicos e operacionais. 1st edn. Brasília: Ministério da Saúde, Coordenação-Geral do Programa Nacional de Controle da Tuberculose. Available from: http://bvsms.saude.gov.br/bvs/publicacoes/panorama%20tuberculose%20brasil_2014.pdf.
    [8] Keeney S, McKenna H, Hasson F, et al. (2011) The Delphi Technique in Nursing and Health Research, 1st edn, Oxford: Wiley-Blackwell, 4–5.
    [9] Ahmad RA, Mahendradhata Y, Cunningham J, et al. (2009) How to optimize tuberculosis case finding: explorations for Indonesia with a health system model. BMC Infect Dis 9: 33–39. doi: 10.1186/1471-2334-9-33
    [10] Passannante MR, Gallagher CT, Reichman LB, et al. (1994) Preventive therapy for contacts of multidrug-resistant tuberculosis: A Delphi survey. Chest 106: 431–434. doi: 10.1378/chest.106.2.431
    [11] Scatena LM, Villa TCS, Palha PF, et al. (2009) Desigualdades no acesso ao tratamento de TB em diferentes regiões do Brasil, In: Duarte FAM, De Jong D, Editor, Tuberculose-Pesquisas Operacionais, 1st edn., São Paulo: FunpecEditora, 179–184.
    [12] Czinkota MR, Ronkainen IA (1997) International Business and Trade in the Next Decade: Report from a Delphi Study. J Int Bus Stud 28: 827–844. doi: 10.1057/palgrave.jibs.8490121
    [13] Liu X, Lewis J, Zhang H, et al. (2015) Effectiveness of Electronic Reminders to Improve Medication Adherence in Tuberculosis Patients: A Cluster-Randomised Trial. PLoS Med 12: e1001876. doi: 10.1371/journal.pmed.1001876
    [14] Libanio PAC (2006) Avaliação Qualitativa do Modelo de Gestão da Política Nacional de Recursos Hídricos: Interfaces com o Sistema Ambiental e com o Setor de Saneamento. Tese de Doutorado. Departamento de Engenharia Sanitária e Ambiental, Escola de Engenharia da UFMG, Belo Horizonte/MG.
    [15] De Loe RC (1995) Exploring complex policy questions using the policy Delphi A multi-round, interactive survey method. Appl Geogr 15: 53–68. doi: 10.1016/0143-6228(95)91062-3
    [16] Karumbi J, Garner P (2015) Directly observed therapy for treating tuberculosis. Cochrane database Syst Rev 5: CD003343.
    [17] Volmink J, Garner P (2003) Directly observed therapy for treating tuberculosis. Cochrane Database Syst Rev 1: CD003343.
    [18] Toczek A, Cox H, Du Cros P, et al. (2013) Strategies for reducing treatment default in drug-resistant tuberculosis: Systematic review and meta-analysis. Int J Tuberc Lung Dis 17: 299–307. doi: 10.5588/ijtld.12.0537
    [19] Sharma SK, Jha S (2015) Directly observed treatment is not the only solution for poor adherence and low cure of tuberculosis. Evid Based Med Month 20: 180. doi: 10.1136/ebmed-2015-110247
    [20] Ministério da Saúde (2006) Plano Estratégico para o Controle da Tuberculose, Brasil 2007–2015. Available from: http://www.paho.org/bra/index.php?option=com_docman&task=doc_view&gid=927&Itemid=423.
    [21] Teixeira TP, Sassi RAM, Cezar-Vaz MR, et al. (2010) Visita domiciliar a contatos de pacientes com tuberculose e sua associação com os fatores socioeconômicos e a cobertura pela Estratégia Saúde da Família no município de Rio Grande, RS. Vitalle Rio Gd 22: 75–85.
    [22] Mendonça SA, Franco SC (2015) Avaliação do risco epidemiológico e do desempenho dos Programas de controle de tuberculose nas Regiões de Saúde do estado de Santa Catarina, 2003 a 2010. Epidemiol e Serviços Saúde 24: 59–70. doi: 10.5123/S1679-49742015000100007
    [23] Homedes N, Ugalde A (2006) Improving access to pharmaceuticals in Brazil and Argentina. Health Policy Plan 21: 123–131. doi: 10.1093/heapol/czj011
    [24] Guerreiro MP, Cantrill JA, Martins AP, et al. (2007) Morbilidade evitável relacionada com medicamentos-Validação de indicadores para cuidados primários em Portugal. Acta Med Port 20: 107–130.
    [25] Fry CL, Ritter A, Baldwin S, et al. (2005) Paying research participants: a study of current practices in Australia. J Med Ethics 31: 542–547. doi: 10.1136/jme.2004.009290
    [26] Gelinas L, Largent EA, Cohen G, et al. (2018) A Framework for Ethical Payment to Research Participants. NEngl J Med 378: 766–771. doi: 10.1056/NEJMsb1710591
    [27] Minayo MCDS (2009) Construção de indicadores qualitativos para avaliação de mudanças. Rev Bras Educ Med 33: 83–91. doi: 10.1590/S0100-55022009000500009
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