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Open Access Research article

Adapting a generic tuberculosis control operational guideline and scaling it up in China: a qualitative case study

Xiaolin Wei1*, John D Walley1, Xinyuan Liang2, Feiying Liu2, Xiulei Zhang3 and Renzhong Li4

Author Affiliations

1 Nuffield Centre for International Health and Development, University of Leeds, UK

2 Guangxi Centre for Disease Control and Prevention, PR China

3 Shandong Centre for TB Control, PR China

4 China National Centre for TB Control and Prevention, PR China

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BMC Public Health 2008, 8:260  doi:10.1186/1471-2458-8-260

Published: 29 July 2008

Abstract

Background

The TB operational guideline (the deskguide) is a detailed action guide for county TB doctors aiming to improve the quality of DOTS, while the China national TB policy guide is a guide to TB control that is comprehensive but lacks operational usability for frontline TB doctors. This study reports the process of deskguide adaptation, its scale-up and lessons learnt for policy implications.

Methods

The deskguide was translated, reviewed, and revised in a working group process. Details of the eight adaptation steps are reported here. An operational study was embedded in the adaptation process. Two comparable prefectures were chosen as pilot and control sites in each of two participating provinces. In the pilot sites, the deskguide was used with the national policy guide in routine in-service training and supervisory trips; while in the control sites, only the national policy guide was used. In-depth interviews and focus groups were conducted with 16 county TB doctors, 16 township doctors, 17 village doctors, 63 TB patients and 57 patient family members. Following piloting, the deskguide was incorporated into the national TB guidelines for county TB dispensary use.

Results

Qualitative research identified that the deskguide was useful in the daily practice of county TB doctors. Patients in the pilot sites had a better knowledge of TB and better treatment support compared with those in the control sites.

Conclusion

The adaptation process highlighted a number of general strategies to adapt generic guidelines into country specific ones: 1) local policy-makers and practitioners should have a leading role; 2) a systematic working process should be employed with capable focal persons; and 3) the guideline should be embedded within the current programmes so it is sustainable and replicable for further scale-up.