Behavioral Barriers of Tuberculosis Notification in Private Health Sector: Policy implication and Practice

Abstract

Under-reporting of new tuberculosis (TB) cases is one of the main problems in TB control, particularly in countries with high incidence and dominating role of a private sector in TB cases diagnosing. The purpose of this paper was to explore behavioral determinants of under-reporting of new TB cases among private sector physicians in Iran. We conducted a population-based, cross-sectional study of physicians working in private clinics. The data collection tool was designed using the theory of planned behavior. We used structural equation models with maximum likelihood estimation to examine attitude towards the notification behavior. Of 519 physicians, 433 physicians completed the questionnaire. Attitude towards notification had the highest score (mean score=87.65; sd=6.79; range: 0-100). The effect of perceived behavioral controls on the notification behavior ((β ̂)= 0.13; CI: .01-.25) was stronger than the total effect of attitude ((β ̂)=0.06; CI: .00-.12) and subjective norms ((β ̂)=0.01; CI: -.00 -.03) on the behavior. However, the attitude was the main predictor of intention and justified 46% of the intention variance. Intention had a significant effect on the behavior ((β ̂)= 0.09; CI:.01- .16). Considering stronger effect of perceived behavioral control on the behavior, interventions aiming at facilitating notification process would be more effective than those aiming at changing the attitude or enhancing intention among physicians. To the best of our knowledge, no other study previously explored determinants of under-reporting from the behavioral and cognitive perspective. Specifically, we explored the role of the theory of planned behavior constructs in predicting intention to notify new TB cases.