An evaluation of community acceptability and adoption of the community-based TB care program using the diffusion of innovation model
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Abstract
Introduction: Community-based tuberculosis (TB) related interventions still face several implementation challenges that negatively affect attainment of overall national TB program goals. Yet, few studies investigate key implementation outcomes such as acceptability and adoption of these interventions. This study sought to explore the acceptability and adoption of health extension worker (HEW) driven community-based TB care (CBTC) program among community members in Gondar town, Northwest Ethiopia.
Methods: A qualitative case study design was employed, consisting of twenty-four in-depth interviews and three FGDs with a purposively selected sample of HEWs, HEWs’ supervisors, TB focal persons and community members. The study utilized deductive thematic analysis guided by Rogers' Diffusion of Innovation theory, which posits that the acceptability and adoption of interventions are influenced by attributes such as relative advantage, observability, compatibility and complexity.
Results: The program’s relative advantage including its perceived ability to promote TB prevention, early diagnosis, as well as the observed improved reporting mechanisms and treatment outcomes arising from HEWs visits facilitated its acceptability and adoption. The integration of community-based TB care into the health system and use of outreach activities to deliver TB information and services enhanced compatibility of the program with community health expectations. However, several factors hindered the delivery of the program, affecting its acceptability and adoption. These included limited career progression for HEWs, inadequate support from the district health office, an insufficient number of HEWs for the growing population, challenges in sustaining TB donor-funded programs, the impact of the civil war, the non-adherence to referral guidelines, and resource constraints.
Conclusion: To enhance the acceptability and adoption of CBTC, we recommended prioritizing community engagement, improving integration of the program in community health systems, addressing contextual challenges such as TB stigma, as well as enhancing program support for the health extension workers.
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