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

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

Behavioral determinant	Arranging home visits	Visiting households to screen contacts	Evaluating contacts in clinics
A. Barriers
Capability^a
Psychological		Lack of TB knowledge among contacts	Lack of local contact investigation guidelines
Psychological		Language barrier for LHWs and contacts	Lack of local contact investigation guidelines
Physical
Opportunity^b
Physical	Insufficient personnel at TB unit	Difficulty locating households	Lack of funds for travel for contacts
Physical	Lack of dedicated clinic space for TB care	Difficulty finding contacts at home	Lack of funds for travel for contacts
Social	Stigma felt by index patients	Avoidant behaviors of contacts	Stigma felt by contacts
Motivation^c
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
Psychological	Ability of LHWs to persuade index patients
Physical
Opportunity
Physical	Task shifting to LHWs	Flexible scheduling of home evaluation	Streamlining contact evaluation at clinic
Physical	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
Social	Trust between index patients and LHWs	Privacy provided by home evaluation	Family social support for contacts
Motivation
Automatic
Reflective		Personalizability of home visit
Reflective		Pay for LHWs

Abbreviations: COM-B Capability, Opportunity, Motivation Determine Behavior Model, LHWs lay health workers, TB tuberculosis
^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)
^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).
^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)

ISSN: 1748-5908