Consensual improvement actions for the Tuberculosis Control Programme in Pernambuco state, Brazil: an e-Delphi study

Simone Santos Bezerra; Mara Pereira Guerreiro; José Lamartine Soares Sobrinho; Simone Santos Bezerra; Mara Pereira Guerreiro; José Lamartine Soares Sobrinho

doi:10.3934/publichealth.2019.3.229

AIMS Public Health

2019, Volume 6, Issue 3: 229-241. doi: 10.3934/publichealth.2019.3.229

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Research article

Consensual improvement actions for the Tuberculosis Control Programme in Pernambuco state, Brazil: an e-Delphi study

1.
Center of Biological Sciences, Post-graduation Programme in Therapeutic Innovation, Federal University of Pernambuco, Cidade Universitária, Recife, Pernambuco, Brazil
2.
Unidade de Investigação e Desenvolvimento em Enfermagem (ui&de), Escola Superior de Enfermagem de Lisboa, Parque das Nações, Av. D. João II, 1990-096, Lisbon, Portugal
3.
Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Instituto Universitário Egas Moniz,Quinta da Granja, 2829, 511 Monte de Caparica, Almada, Portugal
4.
Department of Pharmacy Health Sciences Center, Federal University of Pernambuco-Av. MoraesRego, 123, Cidade Universitária, Recife, Pernambuco, Brazil

Received: 15 February 2019 Accepted: 25 June 2019 Published: 12 July 2019

Objectives: Tuberculosis (TB) remains a major public health problem, particularly in low and middle-income countries. The aim of this study is to consensualise improvement actions for the Tuberculosis Control Programme of the Pernambuco state (SPTC), Brazil. Methods: Firstly, a preliminary workshop was conducted with experts (n = 8), including key stakeholders and health professionals, to select structure and process indicators pertaining to the tuberculosis control programme. Then, an e-Delphi was carried out with a purposive sample of 11 local TB experts. The first-round questionnaire was comprised of 19 open-ended questions on possible improvement actions, based on programme indicators obtained in the previous stage. In the second-round experts rated each action for relevance and feasibility, using a four-point scale. In the last round the participants rated the actions again, in the light of group’s answers. We used published criteria to define consensus at the outset of the study. Key findings: Eighty-nine improvement actions achieved a high degree of consensus in both feasibility and relevance in round three. Eighty-six actions were grouped under 19 structure and process indicators, while three were consideredcross-sectional in scope (i.e. related to more than one indicator). Ten out of the 86 actions obtained at least 70% of ratings on the highest score of the scale both for relevance and feasibility. These included: “Request and availability of sputum pots can be made by any health professional in the health unit”. Conclusions: The wide array of actions obtained in this Delphi represent a resource from which local SPTC services can select the actions most suitable for each context. The ten most relevant and feasible actions represent a particularly useful starting point to streamline change and potentially improve programme indicators.
- Tuberculosis,
- health programs and plans,
- quality improvement,
- Delphi technique
Citation: Simone Santos Bezerra, Mara Pereira Guerreiro, José Lamartine Soares Sobrinho. Consensual improvement actions for the Tuberculosis Control Programme in Pernambuco state, Brazil: an e-Delphi study[J]. AIMS Public Health, 2019, 6(3): 229-241. doi: 10.3934/publichealth.2019.3.229

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Abstract

Objectives: Tuberculosis (TB) remains a major public health problem, particularly in low and middle-income countries. The aim of this study is to consensualise improvement actions for the Tuberculosis Control Programme of the Pernambuco state (SPTC), Brazil. Methods: Firstly, a preliminary workshop was conducted with experts (n = 8), including key stakeholders and health professionals, to select structure and process indicators pertaining to the tuberculosis control programme. Then, an e-Delphi was carried out with a purposive sample of 11 local TB experts. The first-round questionnaire was comprised of 19 open-ended questions on possible improvement actions, based on programme indicators obtained in the previous stage. In the second-round experts rated each action for relevance and feasibility, using a four-point scale. In the last round the participants rated the actions again, in the light of group’s answers. We used published criteria to define consensus at the outset of the study. Key findings: Eighty-nine improvement actions achieved a high degree of consensus in both feasibility and relevance in round three. Eighty-six actions were grouped under 19 structure and process indicators, while three were consideredcross-sectional in scope (i.e. related to more than one indicator). Ten out of the 86 actions obtained at least 70% of ratings on the highest score of the scale both for relevance and feasibility. These included: “Request and availability of sputum pots can be made by any health professional in the health unit”. Conclusions: The wide array of actions obtained in this Delphi represent a resource from which local SPTC services can select the actions most suitable for each context. The ten most relevant and feasible actions represent a particularly useful starting point to streamline change and potentially improve programme indicators.

Acknowledgments

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.We are grateful to Unidade de Investigação e Desenvolvimento em Enfermagem (ui&de), Escola Superior de Enfermagem de Lisboa for supporting the publication of this paper.

Ethics

Participation in this panel could involve expressing views on the quality or performance of the SPTC. One ethical concern is the risk of connecting participants' identities to their responses. Therefore, steps were taken to ensure confidentiality. Participants were asked to provide solely general demographic information, such as age, gender, and years of professional experience. Each expert was assigned a unique identifier, which was kept in a database accessible only to the researchers. Access to data files and electronic mail was protected by passwords. We submitted the study protocol through PlataformaBrasil for ethical approval, which was granted by the Ethics Committee of the auhors' institution.

Conflicts of interest

All authors declare no conflicts of interest in this paper.

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