Research on influencing factors of preventive treatment of latent tuberculosis infection based on thematic analysis:Taking Shijiazhuang City as an example

doi:10.19982/j.issn.1000-6621.20250193

Abstract

Abstract:

Objective: To analyze influencing factors of preventive treatment of latent tuberculosis infection (LTBI) based on thematic analysis, to provide reference for rapid promotion of preventive treatment. Methods: A purposive sampling method was used to select 30 managers involved in all aspects of preventive treatment work in Shijiazhuang City from 2022 to 2023 and 75 latent tuberculosis infectors who met the preventive treatment standard and lived in the city during the same period as the research objects. Semi-structured in-depth individual interview was conducted to collect their understanding and attitude towards preventive treatment policy. Thematic analysis was conducted for summarization and analysis with software MAXQDA 22.0. Through double independent open coding and axial coding, a theme framework of influencing factors of LTBI preventive treatment was constructed, reliability of coding results was evaluated with coding consistency coefficient, then difference in response frequency on the overall theme between latent tuberculosis infectors and preventive treatment managers was analyzed. Results: In-depth interview with 105 subjects formed a final thematic framework of LTBI preventive treatment influencing factors which included four general themes: cognitive factors (95 times), decision support (54 times), risk management (48 times) and policy funds (33 times), covering 8 sub-themes and 230 categories. There was a statistically significant difference in the response frequencies of latent tuberculosis infectors and preventive treatment managers in the overall theme (χ²=13.097, P=0.004). Latent tuberculosis infectors and preventive treatment managers had insufficient knowledge of LTBI and preventive treatment (46 times), latent tuberculosis infectors cannot obtain effective decision support (54 times), difficulties in treatment management (21 times), and lack of policy and financial support (33 times) directly affected the smooth conduction of preventive treatment. Conclusion: Individual cognitive level and health beliefs, timeliness and effectiveness of decision support, risk management, policy and financial support affect the promotion of preventive treatment.

Key words: Mycobacterium tuberculosis, Mycobacterium infections, Protective agents, Factor analysis, statistical

CLC Number:

R521

Shi Xiaojing, Wang Xin, Guo Jianhua, Zhao Qingran, Wang Yuhan. Research on influencing factors of preventive treatment of latent tuberculosis infection based on thematic analysis:Taking Shijiazhuang City as an example[J]. Chinese Journal of Antituberculosis, 2025, 47(10): 1326-1332. doi: 10.19982/j.issn.1000-6621.20250193

Figures/Tables 4

编号	分主题	类别(频次)	LTBI者 (频次)	管理人员 (频次)	合计 (频次)
A1	知晓活动性结核病严重程度和传染性	知道肺结核可以传染给他人(18);学生害怕成为活动性肺结核患者(6);担心得了肺结核会耽误学业(4);与肺结核患者同班级(3);家中有亲人因肺结核去世(1)	17	15	32
A2	正确认识LTBI和预防性治疗的作用	知道预防性治疗可预防活动性肺结核的发生(6);知道LTBI有可能会发展为肺结核(6);认为预防性治疗可以保持身体健康(3);不担心药物不良反应(1);了解LTBI检测阳性的意义(1)	11	6	17
A3	对LTBI及预防性治疗认知不足	LTBI者存在侥幸心理认为自己不会发病(20);不清楚预防性治疗的内容、方法和注意事项(11);家长不认可LTBI初次检查结果(7);认为自己很健康不需要治疗(5);不清楚LTBI筛查阳性的意义(3)	21	25	46
A4	学校/医务人员提供的技术保障与咨询建议	基层医务人员对于LTBI和预防性治疗相关知识不足(12);疾病预防控制中心工作人员对基层医务人员进行技术指导(7);学校给学生报销预防性治疗部分费用(6);向LTBI者详细解释预防性治疗的方案及利弊(6);对家长进行宣传教育使家长重视LTBI(5);教师对学生进行过相关知识宣教(5);教师对于预防性治疗的目标人群了解不全面(3);医生对预防性治疗推荐力度不足(3);鼓励LTBI学生接受预防性治疗(3);医院的医生认为LTBI暂不需要治疗(2);校医认为预防性治疗效果不明显(2)	16	38	54
A5	药物不良反应	担心长期服药影响身体健康(23);注射用母牛分枝杆菌(微卡)使用人群有限制,15岁以下人群不能使用微卡(4)	18	9	27
A6	服务可及性与连续性	口服药时间长,LTBI者不能坚持服药(10);LTBI人员失访(2);存在瞒报现象,隐瞒密切接触人员(2);学生在校期间药物保管问题(1);微卡采购不方便(2);服药后效果不明显(2);LTBI人员不能定期复查(2)	4	17	21
A7	LTBI者家庭经济困难	微卡价格昂贵,经济负担重,家长舍不得打(8);家庭人均年收入≤3万元(4);治疗期间需要多次往返医疗机构会产生交通、时间成本(3);LTBI者直言没钱,负担不起(1)	5	11	16
A8	政府人力、资金投入不足	预防性治疗药品、各项检查均需LTBI者自费(5);缺乏推广宣传经费(4);预防性治疗尚未纳入国家基本公共卫生项目管理(3);用于LTBI者管理的人力资源不足(3);可供选择的预防性治疗方案较少,需要加大研发投入(2)	0	17	17

References 22

[1]	World Health Organization. Global tuberculosis report 2024. Geneva: World Health Organization, 2024.
[2]	赵剑喜, 王铂, 郭强, 等. 甘肃省“十三五”结核病防治规划实施效果分析. 疾病监测, 2024, 39(2):144-149. doi:10.3784/jbjc.202307250370.
[3]	李雪, 阮云洲, 刘小秋, 等. 2011—2019年中国结核病防治工作经费投入与效益产出分析. 中国防痨杂志, 2021, 43(7): 702-707. doi:10.3969/j.issn.1000-6621.2021.07.011.
[4]	国家疾控局, 国家卫生健康委, 国家发展改革委, 等. 关于印发《全国结核病防治规划(2024—2030)年》的通知. 国疾控传防发〔2024〕19号. 2024-11-28.
[5]	师晓晶, 郭建花, 王鑫, 等. 石家庄市结核分枝杆菌潜伏感染者预防性治疗接受度及影响因素研究. 中国防痨杂志, 2025, 47(6):746-752. doi:10.19982/j.issn.1000-6621.20240591.
[6]	徐彩红, 赵雁林. 中国结核病预防性治疗指南. 北京: 人民卫生出版社, 2023:30-46.
[7]	包亮亮, 王新旗, 张燕, 等. 新疆维吾尔自治区南疆地区结核病防治工作实施现状的定性评价——基于扎根理论的质性访谈. 中国防痨杂志, 2024, 46(2):151-157. doi:10.19982/j.issn.1000-6621.20230288.
[8]	徐建平, 张厚粲. 质性研究中编码者信度的多种方法考察. 心理科学, 2005, 28(6):1430-1432. doi:10.3969/j.issn.1671-6981.2005.06.036.
[9]	廖星, 刘建平, Nicola Robisnon, 等. 定性研究方法之框架分析法. 中国中西医结合杂志, 2014, 34(5): 622-626. doi:10.7661/CJIM.2014.05.0622.
[10]	Manoharan A, Siti Nur Farhana H, Manimaran K, et al. Facilitators and barriers for tuberculosis preventive treatment among patients with latent tuberculosis infection: a qualitative study. BMC Infect Dis, 2023, 23(1):624. doi:10.1186/s12879-023-08612-2. pmid: 37740196
[11]	Spruijt I, Haile DT, van den Hof S, et al. Knowledge, attitudes, beliefs, and stigma related to latent tuberculosis infection: a qualitative study among Eritreans in the Netherlands. BMC Public Health, 2020, 20(1):1602. doi:10.1186/s12889-020-09697-z. pmid: 33097021
[12]	秦莉, 赵瑶, 赵鑫, 等. 北京市幼儿园及中小学新生家长结核病防治核心信息知晓率及影响因素分析. 首都公共卫生, 2023, 17 (4): 218-221. doi:10.16760/j.cnki.sdggws.2023.04.007.
[13]	周勇, 闫世春, 于兰, 等. 黑龙江省中小学学生及其家长结核病防治核心知识知晓情况及相关性分析. 中国公共卫生, 2022, 38 (4): 490-493. doi:10.11847/zgggws1133002.
[14]	Parwati NM, Bakta IM, Januraga PP, et al. A Health Belief Model-Based Motivational Interviewing for Medication Adherence and Treatment Success in Pulmonary Tuberculosis Patients. Int J Environ Res Public Health, 2021, 18(24):13238. doi:10.3390/ijerph182413238.
[15]	庞雪雅. 利益表达与体制性迟钝:学校突发公共卫生事件演化研究. 上海:华东政法大学, 2019. doi:10.27150/d.cnki.ghdzc.2019.000705.
[16]	雷蓉蓉, 刘英, 张婷, 等. 重庆市结核病防治医务人员结核潜伏感染及预防性治疗的认知态度分析. 现代预防医学, 2020, 47(9):1647-1650,1669. doi:10.20043/j.cnki.mpm.2020.09.026.
[17]	Sharma N, Basu S, Chopra KK, et al. Awareness and perspectives on expansion of latent TB management among public-sector physicians and medical trainees in Delhi, India. Indian J Tuberc, 2020, 67(2):208-212. doi:10.1016/j.ijtb.2020.02.003. pmid: 32553313
[18]	张静, 付若楠, 王森路, 等. 高负担地区肺结核密切接触者中结核分枝杆菌潜伏感染者预防性治疗接受意愿及影响因素研究. 中国防痨杂志, 2024, 46 (2): 165-172. doi:10.19982/j.issn.1000-6621.20230395.
[19]	Sharma N, Basu S, Khanna A, et al. The intention to receive tuberculosis preventive therapy in adult household contacts of pulmonary TB patients in Delhi, India. J Infect Dev Ctries, 2022, 16 (2): 298-304. doi:10.3855/jidc.14910.
[20]	夏愔愔, 詹思延. 国内抗结核药物不良反应发生率的综合分析. 中华结核和呼吸杂志, 2007, 30(6): 419-423.
[21]	马艳, 成诗明. 加速我国结核潜伏感染筛查与预防性治疗的建议. 实用医学杂志, 2023, 39 (11): 1335-1340. doi:10.3969/j.issn.1006-5725.2023.11.003.
[22]	王前, 周林, 刘二勇, 等. 我国县级结核病定点医疗机构结核病诊断能力现况调查研究. 中国防痨杂志, 2020, 42 (9): 926-930. doi:10.3969/j.issn.1000-6621.2020.09.008.

特征	人数(名)	构成比(%)
性别
男性	39	37.14
女性	66	62.86
年龄组(岁)
10~19	10	9.52
20~29	67	63.81
30~39	11	10.48
40~49	11	10.48
50~59	5	4.76
≥60	1	0.95
人员类型
LTBI者
大学生	64	60.96
高中生	6	5.72
初中生	2	1.90
家务及待业	1	0.95
其他	2	1.90
预防性治疗全流程管理人员
疾病预防控制中心结核科工作人员	9	8.58
结核病定点医院医生	2	1.90
乡镇卫生院结核病防控医生	4	3.81
学校管理人员	3	2.86
教师	6	5.71
校医	5	4.76
宣传人员	1	0.95