title: Barriers and Facilitators of Compliance with Universal Precautions at First Level Health Facilities in Northern Rural Pakistan.
abstract: OBJECTIVE
  We assessed the compliance at first level care facilities (FLCF) with universal precautions (UP) and its behavioral predictors using Health Belief Model (HBM).
  
  
  METHODS
  A sample of FLCF from public clinic (PC), privately owned licensed practitioners' clinic (LPC) and non-licensed practitioners' clinic (NLPC) was obtained. Health Care Workers (HCW) who diagnose and prescribe medication was termed as Prescriber and that carries out prescriber's order was defined Assistant. Compliance to UP was measured on 11 items Likert scale. HCW responded "always" or "often" to all items of UP were added to compute a binary variable of overall compliance. We used linear regression to assess association between HBM and UP score.
  
  
  RESULTS
  We interviewed 485 HCW (75% prescribers) from 365 clinics; mean age 38±10.4 years. Overall, compliance to UP was 6.6%; 11.6% LPC, 5.3% PC, and 4.4% NLPC. Prescribers were less compliant than Assistants. Compliance with not recapping contaminated needle was poor (PC=32%, LPC=33%, NLPC=15%). Compliance with wearing gloves during blood or body fluid exposure was lowest (30%) at PC. Modes of transmission knowledge, self-efficacy and perceived benefits of safe practice, and susceptibility to blood borne infections were positively associated with UP score.
  
  
  CONCLUSIONS
  Higher perception of barriers and severity of blood borne infection result in lower compliance.
authors.affiliation: Dept. of Pediatrics & Child Health, Aga Khan University, Karachi, Pakistan.
authors.forename: Mohammad Tahir
authors.initials: MT
authors.lastname: Yousafzai
authors.affiliation: BC Center for Disease Control, Vancouver, Canada ; School of population and Public health, University of British Columbia, Vancouver, Canada.
authors.forename: Naveed Zafar
authors.initials: NZ
authors.lastname: Janjua
authors.affiliation: Dept. of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia ; Dept. of Community Health Sciences, Aga Khan University, Karachi, Pakistan.
authors.forename: Amna Rehana
authors.initials: AR
authors.lastname: Siddiqui
authors.affiliation: Dept. of Community Health Sciences, Aga Khan University, Karachi, Pakistan.
authors.forename: Shafquat
authors.initials: S
authors.lastname: Rozi
keywords: HBM; Health Care workers; Universal Precautions; blood borne pathogens