Evaluación de la aceptabilidad y adopción por la comunidad del programa comunitario de atención a la tuberculosis en Etiopía mediante el modelo de difusión de la innovación
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Introducción: Las intervenciones comunitarias relacionadas con la tuberculosis siguen enfrentándose a varios retos de implementación que afectan negativamente a la consecución de los objetivos generales del programa nacional de tuberculosis (TB). Sin embargo, son pocos los estudios que han investigado los principales resultados de implementación, como la aceptabilidad y la adopción de estas intervenciones. Este estudio pretendía explorar la aceptabilidad y adopción del programa de atención comunitaria de la tuberculosis (ACT) dirigido por agentes de extensión sanitaria (AES) entre los miembros de la comunidad de la ciudad de Gondar, en el noroeste de Etiopía.
Métodos: Se empleó un diseño cualitativo de estudio de caso, consistente en veinticuatro entrevistas en profundidad y tres grupos de discusión con una muestra seleccionada intencionadamente de agentes de extensión sanitaria, supervisores de estos agentes, personas de contacto para la tuberculosis y miembros de la comunidad. El estudio utilizó un análisis temático deductivo guiado por la teoría de la difusión de la innovación de Rogers, que postula que la aceptabilidad y la adopción de intervenciones están influidas por atributos como la ventaja relativa, la observabilidad, la compatibilidad y la complejidad.
Resultados: La ventaja relativa del programa, incluida su capacidad percibida para promover la prevención de la tuberculosis y el diagnóstico precoz, así como la mejora observada en los mecanismos de notificación y los resultados del tratamiento derivados de las visitas de los AES, facilitaron su aceptabilidad y adopción. La integración de la atención comunitaria de la TB en el sistema sanitario y el uso de actividades de divulgación para ofrecer información y servicios sobre la TB mejoraron la compatibilidad del programa con las expectativas de salud comunitarias. Sin embargo, varios factores agravaron la ejecución del programa, afectando su aceptabilidad y adopción. Entre ellos, la limitada progresión profesional de los AES, el apoyo inadecuado de la oficina de salud del distrito, el número insuficiente de AES para la creciente población, las dificultades para mantener los programas de TB financiados por donantes, el impacto de la guerra civil, el incumplimiento de las directrices de derivación y la escasez de recursos.
Conclusiones: Para mejorar la aceptabilidad y la adopción de la ACT, recomendamos dar prioridad a la participación de la comunidad, mejorar la integración del programa en los sistemas de salud comunitarios, abordar los retos contextuales como el estigma de la tuberculosis, así como mejorar el apoyo del programa a los agentes de extensión sanitaria.
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