Barriers and facilitators of nutrition assessment, counseling and support for Tuberculosis patients: a qualitative study

<title>Abstract</title> <bold>Background: </bold>Provided the significant role of nutrition and proper diet to tuberculosis patients, nutrition assessment, counseling and support has become integral part of tuberculosis treatment. However, proper implementation is crucial to realize its effects, and the barriers and facilitators of implementation has not been studied yet. <bold>Objective: </bold>To explore barriers and facilitators of implementation of Nutrition Assessment, Counseling and Support for tuberculosis patients. <bold>Methods:</bold> An exploratory qualitative study conducted in public health facilities and health offices of Mekelle City, Northern Ethiopia. A total of 17 purposively selected key informants were interviewed. Interviews were tape-recorded, transcribed verbatim, and coded and analyzed using a thematic approach. <bold>Results: </bold>Barriers and facilitators were identified at three levels namely organization, care provider and patient levels. Suboptimal nutritional supply, lack of supportive supervision, lack of adequate work force, staff turn-over, sudden withdrawal of partners and weak link with social service were the barriers at the organization level. Lack of commitment was reported as the only barrier at care provider level and socioeconomic status of patients, sharing and selling of supplies, perceived improved status and perceived stigma were identified as the major barriers for the implementation of nutrition assessment, counseling and support services. While training, availability of measurement and educational tools, inclusion of nutrition indicators in the tuberculosis register, and presence of collaborating partners were identified as facilitators at organizational level. Patients’ motivation to know their health status was reported to be a facilitator at patient level.<bold>Conclusion and Implications:</bold> Organization, care provider and patient level barriers and facilitators found to influence the implementation. Multifaceted approaches are needed for the health system to successfully implement the program and to gain its potential impact.