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Effect of Occupational Tuberculosis Education on Tuberculosis Prevention Practices among Healthcare Workers in Nigeria

Abstract

Tuberculosis (TB) remains an important public health and occupational health concern, particularly among healthcare workers who may experience repeated exposure to patients with suspected or confirmed tuberculosis during clinical care. Healthcare workers may be exposed to tuberculosis through prolonged contact with infectious patients, inadequate ventilation, delayed diagnosis, inappropriate respiratory protection, poor cough control, and weak implementation of tuberculosis infection prevention and control measures. Occupational tuberculosis education provides healthcare workers with knowledge and practical skills relating to tuberculosis transmission, occupational risk factors, early recognition of suspected cases, respiratory hygiene and cough etiquette, appropriate use of personal protective equipment and respirators, environmental and administrative controls, screening, referral, isolation procedures, and other tuberculosis infection prevention measures. Tuberculosis prevention practices refer to actions undertaken by healthcare workers to reduce occupational transmission of tuberculosis, including appropriate use of respiratory protection, implementation of cough etiquette, prompt identification and separation of suspected cases, adequate ventilation, appropriate referral and screening, adherence to infection prevention protocols, and participation in relevant occupational health programmes. In Nigeria, inadequate TB infection prevention training, limited availability of appropriate respiratory protection, poor ventilation, overcrowded healthcare environments, delayed identification of infectious cases, insufficient screening, and weak implementation of TB infection prevention and control measures may increase occupational exposure among healthcare workers. Effective occupational tuberculosis education may improve healthcare workers' knowledge, risk perception, practical skills, and adherence to recommended TB prevention practices. Against this background, this study investigates the effect of occupational tuberculosis education on tuberculosis prevention practices among healthcare workers in Nigeria. The study is anchored on Social Cognitive Theory, the Health Belief Model, and Protection Motivation Theory. Social Cognitive Theory emphasizes the interaction between knowledge, self-efficacy, behavioural capabilities, social influences, and environmental conditions in shaping healthcare workers' tuberculosis prevention behaviour. The Health Belief Model explains preventive health behaviour through perceived susceptibility, perceived severity, perceived benefits, perceived barriers, and cues to action, providing a basis for understanding healthcare workers' adoption of tuberculosis prevention practices. Protection Motivation Theory explains how perceived threat, response efficacy, self-efficacy, and perceived response costs influence individuals' decisions to adopt protective measures against occupational health hazards. Collectively, these theoretical perspectives provide a suitable framework for explaining how occupational tuberculosis education may influence tuberculosis prevention practices among healthcare workers in Nigeria. The study will adopt a quantitative quasi-experimental research design. Primary data will be collected from healthcare workers in selected public and private healthcare facilities in Nigeria using a structured self-administered questionnaire, occupational tuberculosis knowledge assessment, and tuberculosis prevention practices checklist. A multistage sampling technique will be employed to select states, local government areas, healthcare facilities, departments or units, and eligible healthcare workers. Where feasible, selected healthcare facilities or healthcare worker groups will be assigned to intervention and comparison groups. Healthcare workers in the intervention group will receive structured occupational tuberculosis education covering TB transmission, occupational risk factors, signs and symptoms of TB, early identification of suspected cases, respiratory hygiene and cough etiquette, administrative and environmental controls, appropriate use of respirators and other personal protective equipment, ventilation, isolation and referral procedures, TB screening, and relevant infection prevention and control guidelines. Tuberculosis prevention practices will be assessed using indicators such as appropriate use of respiratory protection, adherence to cough etiquette, early identification and referral of suspected TB cases, appropriate separation or isolation procedures, ventilation practices, compliance with TB infection prevention protocols, and participation in recommended occupational TB screening and prevention activities. Where feasible, direct observation will complement self-reported information to improve measurement accuracy. Descriptive statistics will be used to summarize healthcare workers' sociodemographic and professional characteristics, occupational TB knowledge, exposure to education, and TB prevention practices. Inferential statistical techniques, including chi-square tests, paired-sample tests, independent-sample tests, and logistic or multiple regression analysis, will be used to determine the effect of occupational tuberculosis education on tuberculosis prevention practices. Where appropriate, pre-intervention and post-intervention practice scores will be compared. Diagnostic tests will also be conducted to assess the reliability of the research instruments, model assumptions, goodness of fit, and robustness of the findings. The study is expected to find that occupational tuberculosis education has a significant positive effect on tuberculosis prevention practices among healthcare workers in Nigeria. Healthcare workers exposed to structured occupational TB education are expected to demonstrate improved knowledge of TB transmission and greater adherence to recommended prevention measures. Education may improve appropriate use of respiratory protection, cough etiquette, early identification and referral of suspected TB cases, ventilation practices, isolation procedures, screening awareness, and compliance with tuberculosis infection prevention and control guidelines. It may also improve healthcare workers' understanding of their occupational susceptibility to TB and the importance of promptly implementing protective measures. However, education alone may not guarantee sustained TB prevention practices because healthcare workers may continue to face barriers such as inadequate respiratory protection, poor ventilation, overcrowding, limited isolation facilities, insufficient screening programmes, heavy workloads, staff shortages, and weak institutional monitoring. Consequently, occupational tuberculosis education is expected to be most effective when supported by adequate infection prevention infrastructure, appropriate respiratory protection, effective ventilation, routine occupational health programmes, reliable screening and referral systems, and strong institutional TB infection prevention and control policies. The study is expected to contribute to the literature on occupational tuberculosis, tuberculosis infection prevention and control, healthcare worker safety, occupational health, health education, infectious disease prevention, and public health in Nigeria by providing empirical evidence on the effect of occupational tuberculosis education on tuberculosis prevention practices among healthcare workers. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, National Tuberculosis and Leprosy Control Programme, Nigeria Centre for Disease Control and Prevention, state ministries of health, hospital management authorities, infection prevention and control committees, occupational health professionals, healthcare professional associations, public health practitioners, development partners, and policymakers regarding strategies for reducing occupational TB transmission. The study will also provide evidence-based recommendations for strengthening occupational TB education, improving access to respiratory protection, strengthening healthcare facility ventilation and isolation systems, expanding occupational TB screening programmes, improving compliance monitoring, and promoting effective tuberculosis infection prevention and control practices among healthcare workers in Nigeria.

Keywords: Occupational tuberculosis education, tuberculosis prevention practices, healthcare workers, tuberculosis, occupational health, TB infection prevention and control, respiratory protection, TB screening, infectious disease prevention, health education, healthcare safety, public health, Nigeria.