A synthesis of qualitative evidence of barriers and facilitators in implementing guidelines for TB testing in healthcare settings

Table 2 Barriers and facilitators of implementing TB testing guidelines implementation (main findings)

Level	SURE framework domains	Barriers	Facilitators
Recipients of care	Attitudes regarding programme acceptability, appropriateness and credibility	Mistrust of tests and health providers Disbelief of diagnosis Stigma	Trust in doctors and willingness to test
Providers of care	Knowledge and skills	Limited awareness of guidelines Poor understanding of disease Limited skills in sample collection	Knowledge about disease and guidelines
Providers of care	Attitudes regarding programme acceptability, appropriateness and credibility	Lack of confidence in tests Mistrust of guidelines Fear of misusing tests Patient’s reaction guiding practice
Social and political constraints	Donor policies	Donor and WHO dependence Low national policy ownership
Social and political constraints	Influential people		National leadership support Political will Stakeholder engagement
Health systems	Relationship with norms	Low adherence to guidelines Ambiguous guidelines inflexible guidelines Poorly updated guidelines Poor advocacy Rigorous guidelines methodology Poorly adapted guidelines
	Education system	Limited education	Training tools and opportunities
	Patient flow and processes	Poor patient flow process
	Facilities	Poor facilities Logistical and specimen transport issues

ISSN: 2662-2211