title: Provider experiences of the implementation of a new tuberculosis treatment programme: a qualitative study using the normalisation process model.
abstract: BACKGROUND
  Tuberculosis (TB) is a major contributor to the global burden of disease. In many settings, including South Africa, treatment outcomes remain poor. In contrast, many antiretroviral treatment (ART) programmes are achieving high levels of adherence and good outcomes. The ART programme model for maintaining treatment adherence may therefore hold promise for TB treatment. Changing treatment models, however, requires an assessment of how staff receive the new model, as they are responsible for programme implementation. Using the normalization process model as an analytic framework, this paper aims to explore staff perceptions of a new TB treatment programme modelled on the ART treatment programme.
  
  
  METHODS
  A qualitative approach was used. Interviews and focus group discussions were conducted with clinic staff from five intervention clinics. Data were analysed initially using qualitative content analysis. The resulting categories were then organised under the constructs of the normalization process model.
  
  
  RESULTS
  Staff recounted a number of challenges with implementing the programme. Interviews and focus group discussions identified factors relating to the main categories of the normalization process model. The key issues hindering the normalisation of the programme within clinics related to the interactional workability, relational integration and skill-set workability constructs of the model. These included hierarchical relationships, teamwork, training needs and insufficient internalisation by staff of the empowerment approach included in the programme. Logistical and management issues also impacted negatively on the normalization of the programme at the clinics.
  
  
  CONCLUSIONS
  The normalization process model assisted in categorising the challenges experienced during implementation of the intervention. The results suggest that issues remain that need to be resolved before the programme is implemented more widely. Considerable work is needed in order to embed the intervention in routine clinic practice.
authors: Health Systems Research Unit, Medical Research Council of South Africa, Cape Town, South Africa. salla.atkins@ki.se
authors: Salla
authors: S
authors: Atkins
authors: Simon
authors: S
authors: Lewin
authors: Karin C
authors: KC
authors: Ringsberg
authors: Anna
authors: A
authors: Thorson
mesh_terms: D001291:Attitude of Health Personnel; D005260:Female; D017144:Focus Groups; D006302:Health Services Research; D006801:Humans; D008297:Male; D008503:Medical Staff / Q000458:organization & administration / Q000523:psychology*; D017146:Models, Organizational; D016730:Program Development; D015397:Program Evaluation; D036301:Qualitative Research; D013019:South Africa; D014397:Tuberculosis, Pulmonary / Q000628:therapy*; D016903:Drug Monitoring