Effect of Multimodal Strategies on Practices for Tuberculosis Prevention Among Registered Nurses, Outpatient Department, at a Regional Hospital


  • Thunyatorn Khianpanya Graduate Student of Nursing Science program in Nursing Care for Patient with Infectious Disease and Infection Control, Faculty of Nursing, Chiang Mai University
  • Wanchai Lertwatthanawilat Faculty of Nursing, Chiang Mai University
  • Akeau Unahalekhaka Faculty of Nursing, Chiang Mai University


Infection control, Tuberculosis, Outpatient department, Multi-modal intervention, Registered nurse


This quasi-experimental research with one group pretest-posttest design was used to compare the practice of tuberculosis (TB) prevention among registered nurses in an outpatient department at a regional hospital. TB prevention practices were measured before and after implementation of strategies based on the PRECEDE-PROCEED Model by Green and Kreuter (1991). The sample consisted of 11 registered nurses working in the outpatient department and a screening point from August to October 2017. Strategies and methods of promotion consisted of the following three types of factors: 1) Predisposing factors using TB prevention practice education including lectures, discussions, demonstrations, and a return demonstration of the Handbook of Tuberculosis Control Practices; 2) Reinforcing factors using feedback on tuberculosis prevention; and 3) Enabling factors such as providing adequate support for respiratory equipment for both patients and registered nurses. Data were collected using questionnaire and observation of tuberculosis prevention practices. The instrument was tested for content validity and the data collectors were tested for interrater reliability. Data were analyzed by frequency, percentage, mean, and standard deviation by using the chi-squared test statistics or Fisher's Exact Test.

          The study found that after the intervention, the overall performance of the nurses improved from 38.3% to 69.9% which was statistically significant. When analyzed by sub-categories, patient isolation was most widely practiced (86.2%), followed by counseling for patients and relatives while in the examination room (78.3%), patient screening (71.1%), and counseling for patients and relatives in their home (37.9%).  However, the use of respiratory protective equipment (63.0%) and hand hygiene practices (39.3 %) did not significantly changed.

          The study shows that the intervention based on the PRECEDE-PROCEED model resulted in an increase tuberculosis prevention practices among registered nurses.  However, further study is needed to find other strategies to promote the practice of hand hygiene and wearing of N 95 masks.


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Research Article