Abstract
BackgroundThe national tuberculosis strain typing service (TB-STS) was introduced in England in 2010. The TB-STS involves MIRU-VNTR typing of isolates from all TB patients for the prospective identification, reporting and investigation of TB strain typing clusters. As part of a mixed-method evaluation, we report on a repeated cross-sectional survey to illustrate the challenges surrounding the evaluation of a complex national public health intervention.MethodsAn online initial and follow-up questionnaire survey assessed the knowledge, attitudes and practices of public health staff, physicians and nurses working in TB control in November 2010 and March 2012. It included questions on the implementation, experience and uptake of the TB-STS. Participants that responded to both surveys were included in the analysis.Results248 participants responded to the initial survey and 137 of these responded to the follow-up survey (56% retention).Knowledge: A significant increase in knowledge was observed, including a rise in the proportion of respondents who had received training (28.6% to 67.9%, p = 0.003), and the self-rated knowledge of how to use strain typing had improved (‘no knowledge’ decreased from 43.2% to 27.4%).Attitudes: The majority of respondents found strain typing useful; the proportion that reported strain typing to be useful was similar across the two surveys (95.7% to 94.7%, p = 0.67).Practices: There were significant increases between the initial and follow-up surveys in the number of respondents who reported using strain typing (57.0% to 80.5%, p < 0.001) and the proportion of time health protection staff spent on investigating TB (2.74% to 7.08%, p = 0.04).ConclusionsEvaluation of a complex public health intervention is challenging. In this example, the immediate national roll-out of the TB-STS meant that a controlled survey design was not possible. This study informs the future development of the TB-STS by identifying the need for training to reach wider professional groups, and argues for its continuation based on service users’ perception that it is useful. By highlighting the importance of a well-defined sampling frame, collecting baseline information, and including all stakeholders, it provides lessons for the implementation of similar services in other countries and future evaluations of public health interventions.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2458-14-1023) contains supplementary material, which is available to authorized users.
Highlights
The national tuberculosis strain typing service (TB-STS) was introduced in England in 2010
We report in detail on one component of the evaluation: a crosssectional initial and follow-up survey of those delivering and using the TB-STS to assess their knowledge, and to understand the impact of the service on changes in attitudes and practices associated with strain typing
Respondents to the initial survey who did not respond to the follow-up survey were not significantly different to those that responded to both: no particular profession, full-time/part-time position or those working in areas with different TB incidences was more likely to respond to the follow-up survey, and there was no significant difference between the proportion of people who had heard of the TB-STS or had access to strain typing at the time of the initial survey (Table 1)
Summary
The national tuberculosis strain typing service (TB-STS) was introduced in England in 2010. As part of a mixed-method evaluation, we report on a repeated cross-sectional survey to illustrate the challenges surrounding the evaluation of a complex national public health intervention. Complex public health interventions – interventions involving multiple interacting components – when applied at a national level, are often implemented in a way that makes evaluating them with rigorously designed trials difficult [1]. Instead, they require a more pragmatic approach using the available data [2]. We report in detail on one component of the evaluation: a crosssectional initial and follow-up survey of those delivering and using the TB-STS to assess their knowledge, and to understand the impact of the service on changes in attitudes and practices associated with strain typing
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