title: Tuberculosis infection control in a high drug-resistance setting in rural South Africa: information, motivation, and behavioral skills.
abstract: BACKGROUND
  Tuberculosis (TB) is transmitted in resource-limited facilities where TB infection control (IC) is poorly implemented. Theory-based behavioral models can potentially improve IC practices.
  
  
  METHODS
  The 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.
  
  
  RESULTS
  Between 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.
  
  
  CONCLUSIONS
  HCWs 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.
authors.affiliation: Office of Student Affairs, Yale University School of Medicine, New Haven, CT, USA. zkanjee@partners.org
authors.forename: Z
authors.initials: Z
authors.lastname: Kanjee
authors.forename: K R
authors.initials: KR
authors.lastname: Amico
authors.forename: F
authors.initials: F
authors.lastname: Li
authors.forename: K
authors.initials: K
authors.lastname: Mbolekwa
authors.forename: A P
authors.initials: AP
authors.lastname: Moll
authors.forename: G H
authors.initials: GH
authors.lastname: Friedland
mesh_terms: D002983:Clinical Competence; D003428:Cross Infection / Q000517:prevention & control*; D024881:Drug Resistance, Bacterial; D005260:Female; D015658:HIV Infections; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel; D006801:Humans; D017053:Infection Control / Q000706:statistics & numerical data*; D008297:Male; D009042:Motivation; D012424:Rural Population; D013019:South Africa; D011795:Surveys and Questionnaires; D014376:Tuberculosis / Q000517:prevention & control*; D018088:Tuberculosis, Multidrug-Resistant / Q000517:prevention & control*