OBJECTIVE: The aim of this study was to analyse how the implementation strategy of direct observed treatment short course (DOTS) has shaped and influenced patient-provider encounters in a district tuberculosis centre (DTC) in a rural district of India. METHOD: Qualitative methods, combining observations and interviews, were carried out in a DTC focusing on the medical encounters between a TB doctor and his patients. RESULTS: The findings showed that the TB doctor seemed to be working with a dilemma, defined as conflicting accountabilities, in the medical encounters. In an organization perceived as inefficient and resource-constrained, the doctor struggled to find a balance between meeting the obligations of the DOTS programme and meeting the needs and expectations of the patients. Strategies to deal with these conflicting accountabilities were identified as limiting patients' involvement, struggling to maintain authority, and transferring responsibility. CONCLUSION: Professional involvement and patient participation were seen as part of a linked process in this study, and the importance of empowering doctors and health care workers who are implementing DOTS is emphasized. The development of DOTS guidelines needs to be based on the actual process of health care delivery, and staff empowering efforts should also include strengthening of public health care infrastructure.
OBJECTIVE: The aim of this study was to analyse how the implementation strategy of direct observed treatment short course (DOTS) has shaped and influenced patient-provider encounters in a district tuberculosis centre (DTC) in a rural district of India. METHOD: Qualitative methods, combining observations and interviews, were carried out in a DTC focusing on the medical encounters between a TB doctor and his patients. RESULTS: The findings showed that the TB doctor seemed to be working with a dilemma, defined as conflicting accountabilities, in the medical encounters. In an organization perceived as inefficient and resource-constrained, the doctor struggled to find a balance between meeting the obligations of the DOTS programme and meeting the needs and expectations of the patients. Strategies to deal with these conflicting accountabilities were identified as limiting patients' involvement, struggling to maintain authority, and transferring responsibility. CONCLUSION: Professional involvement and patient participation were seen as part of a linked process in this study, and the importance of empowering doctors and health care workers who are implementing DOTS is emphasized. The development of DOTS guidelines needs to be based on the actual process of health care delivery, and staff empowering efforts should also include strengthening of public health care infrastructure.
Authors: Malvika Verma; Karan Vishwanath; Feyisope Eweje; Niclas Roxhed; Tyler Grant; Macy Castaneda; Christoph Steiger; Hormoz Mazdiyasni; Taylor Bensel; Daniel Minahan; Vance Soares; John A F Salama; Aaron Lopes; Kaitlyn Hess; Cody Cleveland; Daniel J Fulop; Alison Hayward; Joy Collins; Siddartha M Tamang; Tiffany Hua; Chinonyelum Ikeanyi; Gal Zeidman; Elizabeth Mule; Sooraj Boominathan; Ellena Popova; Jonathan B Miller; Andrew M Bellinger; David Collins; Dalia Leibowitz; Shelly Batra; Sandeep Ahuja; Manju Bajiya; Sonali Batra; Rohit Sarin; Upasna Agarwal; Sunil D Khaparde; Neeraj K Gupta; Deepak Gupta; Anuj K Bhatnagar; Kamal K Chopra; Nandini Sharma; Ashwani Khanna; Jayeeta Chowdhury; Robert Stoner; Alexander H Slocum; Michael J Cima; Jennifer Furin; Robert Langer; Giovanni Traverso Journal: Sci Transl Med Date: 2019-03-13 Impact factor: 17.956
Authors: Kenneth Kidonge Katende; Mercy R Amiyo; Sarah Nabukeera; Ian Mugisa; Patrick Kaggwa; Stellah Namatovu; Simon Peter Atwiine; Simon Kasasa Journal: PLoS One Date: 2022-09-09 Impact factor: 3.752