Implementation fidelity of management guidelines for hearing loss resulting from treatment of drug-resistant tuberculosis in Kano state, Nigeria
Date
2019
Authors
Muhammad, Sani Ibrahim
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Abstract
Background: Nigeria has a high burden of Tuberculosis (TB) including Drug-resistant
Tuberculosis (DR-TB). Hearing loss is a potential consequence of TB treatment, which has
negatively affected the success of TB control and prevention. The aim of this study was to
assess the Implementation fidelity of management guidelines for hearing loss resulting from
DR-TB treatment and to find factors associated with the Implementation fidelity
Methods: A cross-sectional study, involving health care providers at Infectious Disease
Hospital, Kano was conducted. It was a questionnaire-based assessment of implementation
fidelity as defined by the four domains of content, coverage, duration and frequency of the
Programmatic Management guidelines for treatment of Drug-resistant Tuberculosis. The data
were statistically analyzed in Stata 14.2 (Inc. USA) and regression models were fitted.
Results: The Implementation fidelity was low, which ranged from 40 - 60% (p <0.001). The
core determinants of Implementation fidelity identified based on the conceptual framework
were the facilitation strategies, quality of delivery, intervention complexity, participants’
responsiveness and sociodemographic characteristics. Facilitation strategy, quality of
delivery, intervention complexity, participants’ responsiveness, age, sex, professional cadre
and work experience were individually associated with implementation fidelity among the
health care providers. Among all the determinants, quality of delivery, intervention
complexity, participants’ responsiveness, sex and professional cadre exerted a positive effect
on implementation fidelity (p<0.001) while facilitation strategy, age and work experience
exerted a negative effect on implementation fidelity (p<0.001).
Conclusion: The implementation fidelity of management guideline for hearing loss resulting
from Drug-resistant Tuberculosis treatment was low among health care providers at the
infectious disease hospital, Kano, Nigeria. The study serves as an empirical research in
testing the conceptual framework for assessment of implementation fidelity that was
developed theoretically. Implementation fidelity should be assessed early and at intervals in
the course of implementing the PMDT guideline and indeed, in the course of implementing
any intervention.
Description
A research report submitted to the faculty of Health Science, University of the
Witwatersrand, Johannesburg, in partial fulfilment of the requirement for the degree of
Master of Science in Epidemiology in the field of Implementation science
July 2019