title: Framework of behavioral indicators evaluating TB health promotion outcomes: a modified Delphi study of TB policymakers and health workers.
abstract: BACKGROUND
  Although TB health promotion directed at policy makers and healthcare workers (HCWs) is considered important to tuberculosis (TB) control, no indicators currently assess the impact of such promotional activities. This article is the second in a series of papers that seek to establish a framework of behavioral indicators for outcome evaluation of TB health promotion, using the Delphi method. In the first article, we sought to establish a framework of behavioral indicators for outcome evaluation of TB health promotion among TB suspects and patients. The objective of this second article is to present an indicator framework that can be used to assess behavioral outcomes of TB health promotion directed at policy makers and HCWs.
  
  
  METHODS
  A two-round, modified Delphi method was used to establish the indicators. Sixteen experts who were knowledgeable and experienced in the field of TB control were consulted in Delphi surveys. A questionnaire was developed following 4 steps, and involved ranking indicators on a five-point Likert scale. The consensus level was 70 %. Median, mode, and Coefficient of variation (CV) were used to describe expert responses. An authority coefficient (Cr) was used to assess the degree of each expert's authority.
  
  
  RESULTS
  Consensus was achieved following the two survey rounds and several iterations among the experts. For TB health-promotion activities directed at policymakers, the experts reached consensus on 2 domains ("Resource inputs" and "Policymaking and monitoring behaviors"), 4 subdomains ("Human resources" among others), and 13 indicators ("Human resources per 100,000 person" among others). For TB health-promotion activities directed at HCWs, the experts reached consensus on 5 domains ("Self-protective behaviors" among others), 6 sub-domains ("Preventing infection" among others), and 15 indicators ("Average hours of daily workplace disinfection by ultraviolet radiation" among others).
  
  
  CONCLUSIONS
  This study identified a conceptual framework of core behavioral indicators to evaluate TB health-promotion activities directed at policymakers and HCWs involved in TB control. Validation in other parts of the world could lead to global consensus on behavioral indicators to evaluate TB health promotion targeted at policymakers and HCWs.
authors.affiliation: Department of Social Medicine and Health Service Management, Third Military Medical University, No.30 Gaotanyan Road, Shapingba district, Chongqing, China. lilyliying2012@163.com.
authors.forename: Ying
authors.initials: Y
authors.lastname: Li
authors.affiliation: Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, USA. jehiri@email.arizona.edu.
authors.forename: John
authors.initials: J
authors.lastname: Ehiri
authors.affiliation: Chongqing Institute of TB Prevention and Treatment, Jiulongpo district, Chongqing, China. hkaixiu@126.com.
authors.forename: Daiyu
authors.initials: D
authors.lastname: Hu
authors.affiliation: Department of Epidemiology & Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, USA. eoren@email.arizona.edu.
authors.forename: Eyal
authors.initials: E
authors.lastname: Oren
authors.affiliation: Institute of Toxicology, Third Military Medical University, No.30 Gaotanyan Road, Shapingba district, Chongqing, China. caojia1962@126.com.
authors.forename: Jia
authors.initials: J
authors.lastname: Cao
mesh_terms: D002681:China / Q000453:epidemiology; D032921:Consensus; D003697:Delphi Technique; D005104:Expert Testimony; D005260:Female; D006282:Health Personnel; D006293:Health Promotion; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care; D011795:Surveys and Questionnaires; D014376:Tuberculosis / Q000453:epidemiology* / Q000517:prevention & control*