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Table 2 Barriers and facilitators of key household TB contact investigation activities in terms of their behavioral determinants

From: Identifying barriers to and facilitators of tuberculosis contact investigation in Kampala, Uganda: a behavioral approach

Behavioral determinant Arranging home visits Visiting households to screen contacts Evaluating contacts in clinics
A. Barriers    
Capabilitya    
 Psychological   Lack of TB knowledge among contacts Lack of local contact investigation guidelines
Language barrier for LHWs and contacts
 Physical    
Opportunityb
 Physical Insufficient personnel at TB unit Difficulty locating households Lack of funds for travel for contacts
Lack of dedicated clinic space for TB care Difficulty finding contacts at home
 Social Stigma felt by index patients Avoidant behaviors of contacts Stigma felt by contacts
Motivationc    
 Automatic Fear of getting TB among clinic staff Fear of TB diagnosis among contacts  
 Reflective    Distrust of clinic- staff among contacts
B. Facilitators    
Capability    
 Psychological Interpersonal skills of LHWs   
Ability of LHWs to persuade index patients
 Physical    
Opportunity    
 Physical Task shifting to LHWs Flexible scheduling of home evaluation Streamlining contact evaluation at clinic
Communication with patients via mobile phones Fare for transport of LHWs to homes Family physical support for contacts
 Social Trust between index patients and LHWs Trust between contacts and LHWs Family social support for contacts
Privacy provided by home evaluation
Motivation    
 Automatic    
 Reflective   Personalizability of home visit  
Pay for LHWs
  1. Abbreviations: COM-B Capability, Opportunity, Motivation Determine Behavior Model, LHWs lay health workers, TB tuberculosis
  2. aCapability represents the faculty to engage in a behavior and has a “physical” domain (e.g., strength, skills, stamina) and a “psychological” domain (e.g., knowledge, memory)
  3. bOpportunity represents environmental factors that affect the capability to perform the behavior and has a “physical” domain (e.g., time, physical environment) and a “social” domain (e.g., interpersonal influences, social cues, cultural norms).
  4. cMotivation represents the internal factors that allow one to employ capability and opportunity to perform a behavior, and has a “reflective” domain (e.g., beliefs and intentions) and an “automatic” domain (e.g., wants, needs, impulses)