Organisational Culture and Mask-Wearing Practices for Tuberculosis Infection Prevention and Control among Health Care Workers in Primary Care Facilities in the Western Cape, South Africa

A Qualitative Study

Bibliographic Data

ID15514457
AuthorsIdriss Ibrahim Kallon (0000-0001-8903-4001, University of Cape Town), Alison Swartz (0000-0002-4021-9838, University of Cape Town), C J Colvin (0000-0002-8930-7863, University of Cape Town, corresponding author), Hayley Macgregor (0000-0002-9392-9331, University of Sussex), Gimenne Zwama (0000-0001-9458-522X, Queen Margaret University), Anna Silvia Voce (0000-0001-9082-4449, University of KwaZulu-Natal), Anne D Grant (0000-0002-2437-5195, University of London), Karina Kielmann (0000-0001-5519-1658, Queen Margaret University)
Year2021
Volume18
Issue22
Pages12133-12133
Publication date2021-11-19
Open AccessYes
TypeARTICLE
VenueInternational Journal of Environmental Research and Public Health (JOURNAL)
Journal identifiersISSN: 1661-7827 • E-ISSN: 1660-4601
PublisherMultidisciplinary Digital Publishing Institute (PUBLISHER • CH)
DOI10.3390/ijerph182212133
PMID34831888
OpenAlexW3211920532
LanguageEN
Citations received3
References cited32

Background : Although many healthcare workers (HCWs) are aware of the protective role that mask-wearing has in reducing transmission of tuberculosis (TB) and other airborne diseases, studies on infection prevention and control (IPC) for TB in South Africa indicate that mask-wearing is often poorly implemented. Mask-wearing practices are influenced by aspects of the environment and organisational culture within which HCWs work. Methods : We draw on 23 interviews and four focus group discussions conducted with 44 HCWs in six primary care facilities in the Western Cape Province of South Africa. Three key dimensions of organisational culture were used to guide a thematic analysis of HCWs' perceptions of masks and mask-wearing practices in the context of TB infection prevention and control. Results : First, HCW accounts address both the physical experience of wearing masks, as well as how mask-wearing is perceived in social interactions, reflecting visual manifestations of organisational culture in clinics. Second, HCWs expressed shared ways of thinking in their normalisation of TB as an inevitable risk that is inherent to their work and their localization of TB risk in specific areas of the clinic. Third, deeper assumptions about mask-wearing as an individual choice rather than a collective responsibility were embedded in power and accountability relationships among HCWs and clinic managers. These features of organisational culture are underpinned by broader systemic shortcomings, including limited availability of masks, poorly enforced protocols, and a general lack of role modelling around mask-wearing. HCW mask-wearing was thus shaped not only by individual knowledge and motivation but also by the embodied social dimensions of mask-wearing, the perceptions that TB risk was normal and localizable, and a shared underlying tendency to assume that mask-wearing, ultimately, was a matter of individual choice and responsibility. Conclusions : Organisational culture has an important, and under-researched, impact on HCW mask-wearing and other PPE and IPC practices. Consistent mask-wearing might become a more routine feature of IPC in health facilities if facility managers more actively promote engagement with TB-IPC guidelines and develop a sense of collective involvement and ownership of TB-IPC in facilities

Accountability · Business · Context (archaeology · Environmental health · Focus group · Geography · Health care · Infection control · Qualitative research · Safety culture · Sociology · Thematic analysis · Tuberculosis · Health Policy Implementation Science · Healthcare cost, quality, practices · Healthcare Facilities Design and Sustainability · Medicine · Nursing · Marketing · Surgery

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