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Socio-ecological framework as barriers of TBIC measures - Coggle Diagram
Socio-ecological framework as barriers of TBIC measures
Institutional level barriers
Healthcare system
Shortage of medical supplies and equipment
Shortage of materials and unavailability of equipment including N95 respirators, masks, gowns
Limited supply of PPE
Poor supply and use of respirators
Insufficient supply
Limited availability of protective masks for HCWs
Inadequate provision of masks and tissues to coughing patients
Lack of access to PPE
Non availability of N95 respirators
Limited funding
Prolong shortage, misdistribution and understaffing of HCWs
Staff turnover and migration
Lack of finance
Lack of maintenance to health infrastructure such as x-ray, laboratory and wards
Poor management and planning of health infrastructure
Lack of resources
Healthcare system factors: inadequate infrastructure and a shortage of supplies and equipment
Poor training
Conflicting policy guidelines
Understaffing
Lack of HCWs training on TBIPC
Poor training
Low HCWs training on IC practices
Lack of TBIPC training
Lack of personal protective equipment
Irregular supply of respirators
Dire shortage of N95 respirators
A disproportionate focus on personal respiratory protection of respirators
Irregular supply of N95 respirators
Inadequate spacing at health facilities -isolation, examination, triage
Lack of space to implement the separation of TB suspects
Lack of space
Confined space and isolation rooms
Absence of TB isolation unit for patients within hospitals
Inadequate space for isolation
TBIC measures as increased workload
Additional burden and responsibilities to existing HCWs
TBIC measures were seen as additional tasks for low overstretched staff
Low provider to patients ratios in hospitals
Lack of health facility infrastructure
Poor arrangement of core health services
Lack of maintenance to health infrastructure - x-ray, laboratory and wards
Poor infrastructure
Poor facility infrastructure, building design and inclement climate often lead to poor natural ventilation
Inadequate infrastructure - overcrowding, lack of space, lack of outdoor waiting area
Lack of leadership and management support
Managers lack of knowledge of TBIC and translation to practice
Lack of managerial support
Uncertain leadership
Weak managerial support
No IC committtee
Inadequate implementation of TBIC measures
Inadequate dissemination of TBIC guidelines from focal person
Infectious patients were not separated
Low implementation of cough screening, fast tracking or separation of cough patients or provided masks or tissues to cough patients
Poor coordination of work systems
Poor use of triaging and fast tracking in Nigeria
Lack of triaging for TB patients
Inadequate implementation of administrative control measures
TBIC measures (natural and mechanical, airborne, precaution signage poorly implemented
Inadequate IPC practices
Varied levels of TBIC measures at healthcare settings
Lack of TB screening tools, materials and equipment
Absence of TBIC plan
Cough patients were not separated
Interpersonal level barriers
Poor communication among patients, HCWs and health managers
Work culture
Stagmatization of wearing masks
Lack of perception of TB risk
Sense of invincibility of HCWs
Individual level barriers
HCWs lack of knowledge of TBIC measures
HCWs unaware of correct use of PPE
HCWs poor knowledge of TBIC
Lack of knowledge
Very low knowledge of TBIC among administration and low level staff
Inadequate HCWs training
General discomfort of respirators
Discomfort in using N95 respirators
Discomfort and suffocation due to N95 respirators
Discomfort and appearance of using respirators
Uncomfortable and disrupted masks
Discomfort of wearing a respirator
Distrust of IC efforts by HCWs
HCWs negative attitude towards TBIC measures
Respirators considered uncomfortable and distrust
Discomfort of wearing a respirator
Negative attitude towards TBIC measures
Distrust of IC efforts
HCWs personal commitment
Personal belief of HCWs
Negative attitude of senior staff
Lack of motivation and negative attitude towards TBIC
Limited use of personal respirators among HCWs
Community level barriers
stagmatization
Not wanting to be seen as stigmatizing among TB
Impact of stigma
Family and community stigma
Poor support from district health services
Patients complaints and occasional cold weather as barriers to natural ventilation
Patients non-compliance to cough hygiene
Lack of adherence among patients
High number of TB patients
Increasing TB patients in community
Patients behaviour towards TBIC measures
Poor district health support
Public policy level barriers
Poor public health policy
Ineffective occupational health policy
Poor administrative policy
Poor coordination
Healthcare system factors: inadequate infrastructure and shortage of supplies and equipment
Poor leadership,governance and coordination
Health managers failure to monitor cash flow lead to lack of funds in health services
Failure at provincial level to disburse funds on time
Appropriateness and longevity of the governance structure with health department
Lack of coordination of integrated TB/HIV care
Uncertain leadership
Poor coordination of healthcare resources
Mismatch and demand and supply for program related resources
Variation in diagnosis and treatment strategies employed by providers