Implementation Gap Research Articles

Community-based newborn care intervention fidelity and its implementation drivers in South Wollo Zone, North-east Ethiopia.

Community-based newborn care (CBNC) has been implemented in Ethiopia across the maternal, neonatal, and child health continuum of care with the goal of lowering newborn mortality. However, neonatal mortality rate in Ethiopian is among the highest in the world. Why neonatal mortality remains high in the face of such effective interventions is the issue. As a result, the authors claim that it is unknown whether the planned intervention is carried out effectively or not. The purpose of this study was to investigate the fidelity of community-based newborn care intervention and its implementation drivers. Multicenter community-based mixed method study was employed on 898 postpartum women, 16 health extension workers (HEWs) and 10 health posts to evaluate CBNC intervention fidelity. Structured questionnaire and facility audit checklist was used to collect quantitative data. In-depth interview technique was used to explore lived experiences of HEWs on CBNC implementation. CBNC intervention fidelity was computed as a composite index of the product of program coverage, frequency and contents. Multilevel linear regression model with adjusted β-coefficients at P-value of 0.05 and a 95% confidence interval (CI) were used to declare a significant relation between CBNC intervention fidelity and its implementation drivers. Interpretative phenomenological analysis was employed for qualitative data analysis. CBNC intervention fidelity was found to be 4.5% (95% CI: 3.6-5.4) with only two women received the intervention with full fidelity. The overall CBNC intervention coverage was 38.4% (95% CI: 35.2-41.6). Only 8.1% and 1.5% of women received all CBNC interventions with recommended frequency and content, respectively. HEWs knowledge of danger sign was significant facilitator while lack of: health center's feedback, related short-term training, health development army support, health center staff's technical assistance to HEWs and shortage of medical equipment supply were barriers for CBNC intervention fidelity. In conclusion the CBNC intervention fidelity was too low in this study. This indicates that CBNC intervention package was not implemented as envisioned implying an implementation gap. All implementation drivers were poorly implemented to result in improved fidelity and intervention outcomes.

COVID-19 vaccine eligibility of pregnant and lactating women in Bangladesh: Gap between policy and policy interpretation among policymakers and healthcare workers

SARS-CoV-2 infection in pregnancy is associated with a greater risk of maternal and newborn morbidity and maternal death. Bangladesh confirmed its first COVID-19 case in March of 2020, and vaccination rollout started in January of 2021. In Bangladesh, pregnant women are allowed to receive COVID-19 vaccines during pregnancy with qualifications while lactating women are permitted to receive COVID-19 vaccines with no qualifications as of October 2021. There is limited evidence on how vaccine policies are disseminated, interpreted, and implemented from the national level to the community level in Bangladesh. We conducted in-depth interviews from April-August 2022 with policymakers and healthcare workers in Bangladesh to understand how different stakeholders understood and implemented COVID-19 vaccination policies related to pregnant and lactating women. We interviewed policymakers at three levels: national, divisional, and district, and interviewed healthcare workers from one one urban and three rural communities within one division. We found a gap between policies related to COVID-19 vaccination for pregnant and lactating women and policy interpretation among policymakers and healthcare workers. Policymakers and healthcare workers’ perceptions differed related to policy dissemination, attitudes toward policies related to pregnant and lactating women, and eligibility of pregnant and lactating women. Our findings indicate the need for effective dissemination of and understanding of policies. Within the context of vaccine uptake and vaccine acceptance, policymakers play a critical role as they are charged with developing and disseminating policy related to vaccine eligibility. Healthcare workers rely on timely and accurate communication related to vaccine eligibility, including populations, timing, and locations. Efforts are needed to narrow the policy and policy implementation gap as doing so is crucial to controlling vaccine preventable disease.

Real-world application of a scalable school-based physical activity intervention: A cross-sectional survey of the implementation of The Daily Mile in Greater London primary schools.

School-based physical activity interventions are considered ideal given their potential to reach most children. They can help children achieve the recommended guidelines of 60 minutes of moderate-to-vigorous physical activity per day. The Daily Mile is a popular school-based active mile intervention with a global reach. It recommends ten core principles for successful implementation, three of which are key for effectiveness: that it is quick (15 minutes), the whole school participates, and that it takes place in the school day during lessons (excluding physical education lessons and scheduled breaks). Studies assessing the impacts of The Daily Mile do not often report implementation of the ten core principles which is crucial to identifying the potential impact and feasibility of scalable interventions in real-world settings. Our aim was to assess adherence to The Daily Mile's ten core principles in Greater London primary schools. We created and distributed a survey to 1717 primary schools during September 2020 and achieved a 21% (n = 369/1717) response rate by September 2021. Our sample was representative of Greater London primary schools with responses from every London borough. A total of 196/369 (53%) schools reported implementing The Daily Mile but none of them reported adherence to all ten core principles. Adherence to at least 6/10 principles in various combinations was reported by 54/196 (28%) schools. Only 19/196 (10%) schools that reported implementing The Daily Mile reported adherence to the three key principles recommended for effectiveness. Despite its popularity and global reach, our findings suggest that an implementation gap exists when The Daily Mile is adopted in real-world settings which is likely to challenge its intended purpose. Further research in school settings is needed to understand factors that can improve adherence to increase the potential public health impact of The Daily Mile and other similar interventions.

Green Cities: Utopia or Reality? Evidence from Zurich, Switzerland

There is an overall scientific consensus that green spaces positively affect urban dwellers’ health and well-being. However, there is a gap between knowledge and policy objectives, and their translation into effective interventions to unleash the benefits of green spaces. Examining such ‘implementation gap’ in Zurich is relevant due to the integration of the ‘green urban agenda’ in various Swiss policies. The research narrows its focus to district 9, including the Altstetten and Albisrieden neighborhoods, which contain diverse green spaces despite ongoing densification. The study further explores four green space clusters and their 400-m catchment areas within the district. The research applies a mixed-method approach at three analytical levels: (1) identification of the critical tenets associated with the ‘green urban agenda’ through a review of multi-scale national policies, (2) assessment of green spaces’ provision, types, size, and mutual connectivity in Zurich’s district 9 based on online available quantitative data and on-site observation, and (3) identification of the dominant activities in four green space clusters through on-site observation. Through critical mutual examination of the identified ‘green urban agenda’ principles in the national policies and green space attributes, the findings reveal the extent of the convergence or divergence between policy trends and their implementation in practice.

The Increasing Complexity of Guideline-Directed Medical Therapy for Heart Failure with Reduced Ejection Fraction and Challenges for Real-world Implementation

The latest guidelines for heart failure with reduced ejection fraction (HFrEF) recommend concurrent treatment with four drug classes to improve patient outcomes. While physicians likely have the skillsets needed to navigate the complexities of multiple drug interactions, HF nurse prescribers lack experience needed to implement the latest guideline-directed medical therapy (GDMT). As nurse-led HF services continue to expand, implementing GDMT is essential for gold-standard care. We describe and compare the abilities of physician-led and nurse-led HF clinics in implementing GDMT in HFrEF within the outpatient setting. A retrospective multi-centre cohort study was performed on the pharmacotherapy patterns of HFrEF patients attending either a physician-led or nurse-led HF clinic in 2021. Pharmacotherapy patterns of prescribing on the pillars of HFrEF therapy were collected: ACEi/ARB/ARNi, BB, MRA, SGLT2i. 164 and 231 HFrEF patients were reviewed in a physician-led and nurse-led group respectively. Compared to physicians, there were significantly lower rates of MRA (42.0% vs 62.8%, P < 0.001) and SGLT2i (7.8% vs 24.4%, P < 0.001) prescribed by nurses. Most patients seen by physicians were treated with three drug classes (45.7%) versus two drug classes (50.2%) when seen by nurses. Ongoing gaps in GDMT implementation are driven by the suboptimal MRA and SGLT2i use. Patients seen by nurses were treated with less drug classes and less likely to be treated with MRA and SGLT2i compared to physicians. These findings highlight the ongoing difficulties autonomous nurse prescribers face in HF prescribing and the need for further educational supports.

Implementation of disaster risk reduction management of Visayas state university, Tolosa, province of Leyte-Philippines

In Leyte, one of the Philippines’ disaster-prone provinces, effective Disaster Risk Reduction Management (DRRM) is crucial for safeguarding lives and properties. This research explored gaps in DRRM implementation at Visayas State University Tolosa for 2022 using a qualitative case study approach. Focusing on the university’s Disaster Risk Reduction and Management Committee, comprising seven members, semi-structured interviews were conducted to discuss policy and standard requirements for academic institutions, observing ethical research principles. Four themes emerged: Institutional Preparedness, Disaster Risk Prevention and Awareness, Lifesaving and Protective Equipment, and Budget for Resilient Building Reconstruction. Key findings highlighted the importance of enhancing the university’s disaster policies, strategies, and building infrastructure. Adherence to the Philippine Building Code and a specific emergency plan, coupled with increased awareness campaigns, were deemed essential for improved safety. Notably, gaps were identified in the provision of rapid communication technology, solar lighting, powerful generators, and emergency vehicles. The study also underscored the necessity for dedicated funding to foster resilient building infrastructure, ensuring a safe environment for the university community.&#x0D; Keywords: Implementations; Disaster Risk Reduction Management; School.

Covid-19 pandemic: A necessary catalyst for e-learning adoption and application

The Covid-19 pandemic brought the world to a grinding halt, adversely affecting almost every sector including the post school education and training (PSET) sector. The South African PSET sector is no exception. The academic enterprise was abruptly disrupted and led to a serious loss of teaching and learning time as the government passed new regulations discouraging movement and physical meetings of people. The state of disaster regulations and lockdown directives pronounced during March 2020 by the South African government presented an unprecedented way of operating since the formation of many higher education institutions (HEIs). This study assesses the state of e-learning before and after the first six weeks of lockdown regulations in two HEIs, using a theoretical framework of e-learning system readiness assessment and a participatory research approach. The study reveals a state of under-preparedness by HEIs to operate under the lockdown regulations, due to the adopted blended learning policy implementation gap. Based on these findings, the study concludes with an argument that the Covid-19 pandemic presented a great opportunity for HEIs not only to adopt e-learning at the policy level but also to adapt to the new e-learning methods and practices and thus prepare universities for times of uncertainty.

Examining the Implementation of Girls' Education Policy in Afghanistan

This research examines the implementation of educational policies with a special focus on girls' education policy in Afghanistan. Education is a fundamental right and a driving force behind societal and personal advancement. Despite the existence of educational policies, many nations, like Afghanistan, still struggle with their proper implementation. This study aims to pinpoint the fundamental elements that influence how policies are carried out in Afghanistan and investigate the difficulties encountered when doing so, with a particular emphasis on the education of girls. This study makes recommendations to improve policy implementation procedures in Afghanistan through the use of a qualitative case study and examination of official documents, reports, and literature. It also aims to uncover the underlying drivers and causes of the implementation gap. Understanding the challenges and obstacles encountered in Afghanistan when putting educational policies into practice can advance knowledge of the implementation of policies in related fields and increase the efficacy of Afghan policies promoting gender equality and access to education. In general, the results obtained from this research show that the implementation of girls' education policy in Afghanistan has faced significant challenges due to factors such as limited infrastructure, insufficient resources, security threats, cultural norms and gender violence. In addition to recommendations such as strengthening cooperation, allocating resources, increasing teacher training, challenging cultural norms, and ensuring the coordination of related institutions. These suggestions can significantly improve policy implementation and promote gender equality in education in Afghanistan.

Mooring in the green room. Sailors’ preferences and willingness to pay for green policies in marinas

‘Going green’ is still challenging in the yachting industry partly due to the lack of consumer-centric approaches. This study assesses sailors' preferences and willingness to pay for green policies in marinas, in the context of other measures to increase health security and digital transformation. To do so, a choice experiment was designed through the lens of stakeholders and supported by the Delphi technique. The study is based on the marinas of the Canary Islands in the Atlantic crossing and involved European sailors as potential users. Data confirm that sailors' utility and intention to visit marinas increase the most when ambitious green programs are in place, thereby confirming a high environmental sensitivity among them. More specifically, solar energy use, single-use plastic eradication, and waste recycling are the programs with the greatest positive impact on sailors' willingness to pay. This indicates a potential profitability and market opportunities derived from more environmental friendly practices in marinas. The study opens a new perspective to improve incentive and funding schemes and close implementation gaps in recreational ports.

Taking stock of the implementation gap in climate policy

Taking stock of the implementation gap in climate policy

Women Development Related Policies in Pakistan: A Preliminary Gap Analysis

Women living in third-world countries, such as Pakistan, often face the perception of being less competent and less significant participants in national development. In the Pakistani context, this situation can be attributed, among other factors, to the lack of tangible policies ensuring women's access to key decision-making positions and opportunities for career development. This paper aims to examine the major policies concerning women that have been formulated over the years in the form of acts and laws. Additionally, the study highlights the inadequate attention given by Pakistani policymakers to acts or bills that would facilitate women's career development. The research reveals that the National Commission on the Status of Women (NCWS) in 2012 and subsequent initiatives in 2014, 2016, and 2018 do not fully address the issues related to women's career development. Furthermore, the study uncovers a gap between the policy measures outlined in the first national-level policy for women in 2002, which encompass social, economic, and political dimensions, and their implementation in assisting Pakistani women in their career development. Therefore, this study makes a significant contribution by promoting research on women's status, not only by reporting factors of gender discrimination and cultural restraints but also by analyzing the historical development of official policies and the implementation gap concerning women's career development in Pakistan.

Building bridges in policy implementation during a pandemic: insights from an e-survey on Indian Producer Organisations

ABSTRACT Despite the widely acknowledged importance of consultative policymaking, interventions to encourage stakeholder participation remain scarce. The presence of exigencies, such as the pandemic, can further normalise the lack of participative processes unless serious alternatives are presented. This paper presents the results of an exercise, during the pandemic, on Farmer Producer Organisations (FPOs) through an e-survey of stakeholders whose views, if considered, could have avoided some of the implementation gaps and challenges before the rollout. The survey process demonstrates how facilitated and well-designed consultations can enable a better buy-in in policy implementation and importantly help build state capacity through such processes, despite the pandemic. The paper also highlights the need for scholars and citizens to pay greater attention to the everydayness of policy implementation beyond presenting critiques of policy formulation.

NYS Nonprofit Hospital Assessment and Response to Environmental Pollution as Community Health Need: Prevalence in Community Benefit Practices.

Given the impact of environmental pollution on health and health inequity, there may be substantial value in integrating assessment and response to pollution into nonprofit hospital community benefit processes. Such hospital engagement has not yet been studied. We take a preliminary step of inquiry in investigating if nonprofit hospitals in New York State (NYS) assess, identify, or respond to environmental pollution as part of community benefit processes. This study is of retrospective, observational design. Data were abstracted from community health needs reports (2015-2017), associated implementation plans, and related IRS (Internal Revenue Service) filings from a randomly geographically stratified selection of NYS nonprofit hospitals. The sample includes 53 hospitals from 23 counties. The sampling frame consists of NYS nonspecialty private nonprofit hospitals. Dichotomous findings for the following: (1) engagement of environmental pollution in the process of assessment of community health needs; (2) environmental pollution concern identified as a priority community health need; (3) strategic planning present to address pollution identified as community health need; and (4) action taken on same. We found that 60.5% (95% confidence interval [CI], 0.46-0.74) of hospitals evidenced some form of assessment of environmental pollution and 18.9% (95% CI, 0.09-0.32) identified pollution as a priority community health need. However, no hospital went on to take independent or collaborative planning or action to address pollution. In additional analysis, we found that social justice in hospital mission was a positive predictor of assessment of environmental pollution. For NYS hospitals, we found a substantial presence of assessment and identification of pollution as a community health concern. Our finding of the absence of response to environmental pollution represents a gap in community benefit implementation. This indicates a yet untaken opportunity to address racial and economic environmental health injustices and to improve population health.

Assessing Implementation of Social Screening Within US Health Care Settings: A Systematic Scoping Review.

Though a growing crop of health care reforms aims to encourage health care-based social screening, no literature has synthesized existing social screening implementation research to inform screening practice and policymaking. Systematic scoping review of peer-reviewed literature on social screening implementation published 1/1/2011-2/17/2022. We applied a 2-concept search (health care-based screening; social risk factors) to PubMed and Embase. Studies had to explore the implementation of health care-based multi-domain social screening and describe 1+ outcome related to the reach, adoption, implementation, and/or maintenance of screening. Two reviewers extracted data related to key study elements, including sample, setting, and implementation outcomes. Forty-two articles met inclusion criteria. Reach (n = 7): We found differences in screening rates by patient race/ethnicity; findings varied across studies. Patients who preferred Spanish had lower screening rates than English-preferring patients. Adoption (n = 13): Workforce education and dedicated quality improvement projects increased screening adoption. Implementation (n = 32): Time was the most cited barrier to screening; administration time differed by tool/workforce/modality. Use of standardized screening tools/workflows improved screening integration. Use of community health workers and/or technology improved risk disclosure and facilitated screening in resource-limited settings. Maintenance (n = 1): Only 1 study reported on maintenance; results showed a drop in screening over 21 months. Critical evidence gaps in social screening implementation persist. These include gaps in knowledge about effective strategies for integrating social screening into clinical workflows and ways to maximize screening equity. Future research should leverage the rapidly increasing number of screening initiatives to elevate and scale best practices.

The juridification of social accounting and the transposition process of the non-financial reporting directive 2014/95/EU

PurposeThis paper aims to critically analyse the transposition implications of Union Directive 2014/95. This Directive identified the need to raise the transparency of the social and environmental information provided by the undertakings to a similarly high level across all Member States.Design/methodology/approachThe paper considers how the European Member States of the European Union (EU) have transposed Directive 2014/95 into their regulations. The focus is on the juridification of social accounting in the pursuit of creating an overlapping consensus through Habermas’s concept of internal colonisation. The paper uses qualitative content analysis to scrutinise the national laws that transpose Directive 2014/95, discussing both what has been accomplished and what can be achieved by the release of future legislative provisions.FindingsDespite the aim of Directive 2014/95 to create a common language for disclosing non-financial information, this study shows an implementation gap among and between Member States and an inconsistent picture of the employment of this Directive. Its implementation in the 28 European countries was considered a process of colonisation in implementing Union directives among European undertakings. However, the implementation process, which exemplifies Habermas’s juridification, has failed due to the lack of balance between moral discourse and actions.Originality/valueThis paper contributes to the ongoing debates concerning the implementation of mandatory disclosure of environmental and social information in the EU Member States, promoting new directions for the EU’s democratic laws on social accounting. In addition, it offers an example of how internal colonisation only catalyses effects when moral laws are legitimised through the provision of procedures.

Implementing the voluntary guidelines for the marking of fishing gear in eastern Caribbean small-scale fisheries: An assessment of gear marking provisions

Managing abandoned, lost and otherwise discarded fishing gear (ALDFG) is a critical challenge that can be aided by the establishment of strong provisions for the marking of gear. This study presents an analysis of implementation of the VGMFG in Eastern Caribbean states. It provides a socio-legal review of this issues and an analysis of compliance and implementation gaps. Empirical data was gathered through interviews with 56 fishers in 2 jurisdictions as well as 6 national and regional fisheries management experts.Antigua and Barbuda's Fisheries Regulations provided the strongest support to implementation of the VGMFG, while neither Dominica nor Grenada had weak regulatory support for gear marking. Both fishers and fisheries managers in the region confirmed compliance and implementation gaps in the establishment of gear marking schemes, while regional fisheries experts highlighted the limited human, financial and infrastructural capacity of departments to effectively implement such schemes along with other ALDFG management measures.

Knowledge, attitude, implementation and satisfaction levels regarding availability of resources for airborne infection control among the nursing staff of a medical college in central India during the COVID-19 pandemic

Implementing airborne infection control measures as per guidelines are very important in preventing the spread of airborne infections. Therefore the purpose of this study was to evaluate the gaps in knowledge, attitude, implementation and satisfaction levels regarding the availability of resources for airborne infection control among the nursing staff of a medical college in central India during the COVID-19 pandemic. A cross-sectional survey was done in which 109 nurses participated. This self-administrable questionnaire contained five parts (General information, knowledge, attitude, implementation and satisfaction regarding available resources) and was distributed to the participants. The correct responses as per the National airborne infection control guideline, Ministry of Health and family Welfare, Government of India, 2010 (NAIC) were scored and assessed. The mean age of the participants was 28.9 + 3.02 years. The mean scores out of total score of 10 were 5.48 + 1.2 for knowledge, 6.78 +1.0 for attitude, 5.21 + 1.1 for implementation, and 4.28 + 0.9 for satisfaction of available resources. The knowledge was adequate in 46.8%, the attitude was positive in 89.9 %, the guideline implementation was adequate in 45.9% and the resource satisfaction was only in 9.2% of study participants. Although the nurses had a positive attitude to airborne infection control practices, the overall knowledge and implementation of NAIC were barely adequate and the majority of subjects felt gaps in the availability of resources in implementations of these guidelines. Therefore, it is recommended to enforce their training, ensuring better availability of resources and strict monitoring from hospital administrations for better implementation of NAIC.

Crip-queer intimacy, alliance and activism: towards holistic sexuality education in Taiwan

ABSTRACT This study investigates the significance of sexuality education for individuals with disabilities in Taiwan. It highlights the importance of understanding sexuality as a fundamental aspect of identity, encompassing intimate relationships and connection to others. Since the implementation of the Gender Equity Education Act in 2004, Taiwan has made efforts to include comprehensive sexuality education in the school curriculum and integrate disabled students into mainstream education. However, disabled individuals still face barriers due to ableism and heteronormativity, which impede their access to sexual and reproductive health services, including sexuality education. To address this issue, we conducted a qualitative investigation using narrative and policy data, drawing on Scott’s phenomenology of nothingness and crip theory to explore the intersection of sexualities and disabilities in educational contexts. Our findings reveal that individuals with disabilities in Taiwan often rely on pornography and other erotic materials as informal sources of sex education. Hand Angels, a volunteer-based group established in 2013, has been actively promoting sexual rights within disability rights organisations, advocating for a comprehensive, sex-positive, pleasure-focused, and rights-based approach to sexuality education. However, there are still gaps in knowledge production and policy implementation, which systematically deny people with disabilities their right to sexual agency.

Evaluating the translation of implementation science to clinical artificial intelligence: a bibliometric study of qualitative research.

Whilst a theoretical basis for implementation research is seen as advantageous, there is little clarity over if and how the application of theories, models or frameworks (TMF) impact implementation outcomes. Clinical artificial intelligence (AI) continues to receive multi-stakeholder interest and investment, yet a significant implementation gap remains. This bibliometric study aims to measure and characterize TMF application in qualitative clinical AI research to identify opportunities to improve research practice and its impact on clinical AI implementation. Qualitative research of stakeholder perspectives on clinical AI published between January 2014 and October 2022 was systematically identified. Eligible studies were characterized by their publication type, clinical and geographical context, type of clinical AI studied, data collection method, participants and application of any TMF. Each TMF applied by eligible studies, its justification and mode of application was characterized. Of 202 eligible studies, 70 (34.7%) applied a TMF. There was an 8-fold increase in the number of publications between 2014 and 2022 but no significant increase in the proportion applying TMFs. Of the 50 TMFs applied, 40 (80%) were only applied once, with the Technology Acceptance Model applied most frequently (n = 9). Seven TMFs were novel contributions embedded within an eligible study. A minority of studies justified TMF application (n = 51,58.6%) and it was uncommon to discuss an alternative TMF or the limitations of the one selected (n = 11,12.6%). The most common way in which a TMF was applied in eligible studies was data analysis (n = 44,50.6%). Implementation guidelines or tools were explicitly referenced by 2 reports (1.0%). TMFs have not been commonly applied in qualitative research of clinical AI. When TMFs have been applied there has been (i) little consensus on TMF selection (ii) limited description of selection rationale and (iii) lack of clarity over how TMFs inform research. We consider this to represent an opportunity to improve implementation science's translation to clinical AI research and clinical AI into practice by promoting the rigor and frequency of TMF application. We recommend that the finite resources of the implementation science community are diverted toward increasing accessibility and engagement with theory informed practices. The considered application of theories, models and frameworks (TMF) are thought to contribute to the impact of implementation science on the translation of innovations into real-world care. The frequency and nature of TMF use are yet to be described within digital health innovations, including the prominent field of clinical AI. A well-known implementation gap, coined as the "AI chasm" continues to limit the impact of clinical AI on real-world care. From this bibliometric study of the frequency and quality of TMF use within qualitative clinical AI research, we found that TMFs are usually not applied, their selection is highly varied between studies and there is not often a convincing rationale for their selection. Promoting the rigor and frequency of TMF use appears to present an opportunity to improve the translation of clinical AI into practice.

Barriers to tuberculosis treatment adherence in high-burden tuberculosis settings in Ashanti region, Ghana: a qualitative study from patient’s perspective

BackgroundDespite having an effective community-based Directly Observed Therapy Short-course (DOTS) strategy for tuberculosis (TB) care, treatment adherence has been a major challenge in many developing countries including Ghana. Poor adherence results in discontinuity of treatment and leads to adverse treatment outcomes which pose an increased risk of drug resistance. This study explored barriers to TB treatment adherence and recommended potential patient-centered strategies to improve treatment adherence in two high-burden TB settings in the Ashanti region of Ghana.MethodsThe study was conducted among TB patients who defaulted on treatment in the Obuasi Municipal and Obuasi East districts in the Ashanti region. A qualitative phenomenology approach was used to explore the barriers to TB treatment adherence. Purposive sampling was adopted to select study participants with different sociodemographic backgrounds and experiences with TB care. Eligible participants were selected by reviewing the medical records of patients from health facility TB registers (2019–2021). Sixty-one (61) TB patients met the eligibility criteria and were contacted via phone call. Out of the 61 patients, 20 were successfully reached and consented to participate. In-depth interviews were conducted with participants using a semi-structured interview guide. All interviews were audio recorded and transcribed verbatim. The transcripts were imported into Atlas.ti version 8.4 software and analyzed using thematic content analysis.ResultsFood insecurity, cost of transportation to the treatment center, lack of family support, income insecurity, long distance to the treatment center, insufficient knowledge about TB, side effect of drugs, improvement in health after the intensive phase of the treatment regimen, and difficulty in accessing public transportation were the main co-occurring barriers to treatment adherence among the TB patients.ConclusionThe main barriers to TB treatment adherence identified in this study reveal major implementation gaps in the TB programme including gaps related to social support, food security, income security, knowledge, and proximity to treatment centers. Hence, to improve treatment adherence there is a need for the government and the National Tuberculosis Programme (NTP) to collaborate with different sectors to provide comprehensive health education, social and financial support as well as food aid to TB patients.