Table 6 Examples of meaning units, sub-themes and themes from content analysis of in-depth interviews data about the perception of staff in relation to Directly Observed Treatment for Multidrug Resistant Tuberculosis

“Our main challenge is health staff’s fear toward MDR-TB. One of the factors is uneven knowledge distribution among health staffs. The more we know (about MDR-TB), the more we are scared” (Health staff 4)

Health staff’s fear toward MDR-TB

Fear is a natural expression of health staff when they know about MDR-TB

Fear

Feeling safe/unsafe as an interaction between fear, perceived risk and security, as well as level of knowledge.

“Health staffs were scared to get infected. Fear is human, is not it?” (Health staff 1)

Fear is human

Fear is a natural expression

Health staff were scared to get infected

–

Perceived risk

“They (health staffs) were shocked when they found out there was an MDR-TB patient here” (Health staff 16)

The health staff were shocked when they found out there was an MDR-TB patient at the PHC

–

“Masks have been provided at the registration desk. There were TB patients here, but health staffs did not wear it. Moreover, there will be MDR-TB patient here” (Health staff 13)

The health staff (at the registration desk) did not wear mask, while there will be MDR-TB patient (at the PHC)

Awareness about risk of being infected is low

“We are at high risk of getting infected, however there is no certainty on our insurance if we are infected” (health staff 9)

No certainty on our insurance if we are infected

Lack security for staff in doing DOT for MDR-TB patients.

Perceived security

“They are scared to death. There is no insurance or guarantee of safety from the management” (Health staff 5)

There is no insurance or guarantee of safety from the management

“…Our intention is to help patient, and we have no choice. We are sure we will be safe as long as our infection control is adequate” (Health staff 11)

We will be safe as long as our infection control is adequate

The infection control is perceived inadequate

“We will not get infected if the Infection Control is adequate” (Health staff 11)

The health staff will not get infected if the infection control is adequate

Infection control application is perceived essential to prevent MDR-TB transmission

“First of all, they were afraid to get infected and they are questioning whether the Infection Control has been adequate yet” (Health staff 10)

Health staff are questioning whether the infection control has been adequate yet

The infection control is perceived inadequate

“It will be useless to give training to the health staff. If they are scared, it’s personal…” (Health staff 2)

It will be useless to give training to give training

Current content of training can be not effective to reduce fear

Knowledge

“When they (health staffs) were surveyed, the result might show low knowledge. It is because uneven knowledge distribution among health staffs” (Health staff 1)

Uneven knowledge distribution among health staff

Need more staff to be trained

“…Because we have not got the training so our fear beats everything” (Health staff 10)

Health staff have not got the training

Fear is bigger when the staff have not received training

“Most of health staffs only focus on their job, for instance nurse and nutritionist did not understand about this matter (MDR-TB)” (Health staff 1)

The health staff did not understand about MDR-TB

Information about MDR-TB is still limited among health staff

“There is indeed fear toward MDR-TB. Health staffs should understand on infection control of MDR-TB. Therefore, dissemination of information is very important”

Dissemination of information (about infection control of MDR-TB) is important

–

“Overall, PHCs are ready. There are only few health staff who still discriminate MDR-TB patient because of scared” (Health staff 2)

Few health staff discriminate MDR-TB patients because of scared.

Fear is a driver to a stigmatic attitude to MDR-TB patients

Stigmatic attitude

Fear as a driver of stigmatic attitude

Fear