Establishing Consensus of Perceived Occupational Risk of Tuberculosis (POR-TB) Among Healthcare Workers: A Delphi Study in Indonesia

Establishing Consensus of Perceived Occupational Risk of Tuberculosis (POR-TB) Among Healthcare Workers: A Delphi Study in Indonesia | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Establishing Consensus of Perceived Occupational Risk of Tuberculosis (POR-TB) Among Healthcare Workers: A Delphi Study in Indonesia Agus Fitriangga, Wilson Wilson, Risa Febriana Musawaris, Desni Yuniarni, and 8 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7763696/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 15 Dec, 2025 Read the published version in Discover Public Health → Version 1 posted 12 You are reading this latest preprint version Abstract Background: Healthcare workers (HCWs) in high tuberculosis (TB) burden countries, including Indonesia, face substantially elevated occupational risk of Mycobacterium tuberculosis infection and disease. Understanding HCWs’ perceived occupational risk is essential for designing effective infection prevention and control (IPC) measures. There is currently no validated, context-specific tool in Indonesia that can be used to measure this construct. The CHART-TB project seeks to fill this gap through the development of a Perceived Occupational Risk of Tuberculosis (POR-TB) questionnaire. The aim is to get experts to agree on the content and structure of the POR-TB questionnaire through a multi-round Delphi process. Methods: A modified Delphi method was conducted in three rounds between April and June 2024. The questionnaire comprised five domains: perceived TB risk (9 items), workplace safety (29 items), TB-related stigma (7 items), latent TB knowledge (6 items), and pulmonary TB knowledge (11 items). In Round 1, an online discussion with 12 experts in TB control, occupational health, behavioural science, and public health generated and refined the initial item pool. In Rounds 2 and 3, experts rated the relevance and importance of each item on a 5-point Likert scale (1 = not important to 5 = very important). Consensus was defined as ≥75% agreement (ratings of 4 or 5) with an interquartile range (IQR) ≤1. Results: Round 1 produced 63 items across the five domains. In Round 2, 57 items (90.5%) achieved the consensus threshold, whereas 6 items were revised for clarity in response to qualitative feedback. In Round 3, all 63 items were agreed upon, with median scores between 4.7 and 5.0 and agreement rates between 88% and 100%, showing that the agreement was very stable. The original structure of the domain was kept, and no items were taken away. Conclusion: The three-round Delphi process produced a POR-TB questionnaire containing 63 items with strong expert consensus in five domains that form the core of TB risk perception in the workplace among healthcare workers. The instrument will undergo psychometric validation in a larger, multi-provincial study to establish its reliability and validity for guiding targeted TB IPC interventions in Indonesian healthcare settings. Tuberculosis healthcare workers occupational health risk perception Delphi method Figures Figure 1 Introduction Tuberculosis (TB) remains an important occupational hazard for healthcare workers (HCWs), particularly in high burden countries, including Indonesia, where exposure to undiagnosed TB cases and as it occurs, HCWs are highly prevalent in clinical settings [1]. The available evidence since suggests that nosocomial transmission and infection control deficiencies considerably raise the risk of TB in HCWs, with some studies reporting rates of Latent Tuberculosis Infection (LTBI) over 25% in primary care staff [2]. Health care protective practices and compliance with preventive measures depend on risk perception. Yet, the local situation in a regional setting, as in Indonesia, is less understood [3] Perceived occupational risks, for example, perceived severity, vulnerability, control and emotional distress, are psychological constructs that affect how healthcare workers perceive and react to the dangers of tuberculosis. One research with structural equation modelling (SEM) found that perceived beliefs of feasibility in controlling situations may play an even more important role than perception of threat in risk taking. This indicates that interventions need to enhance personal efficacy about preventing exposure to TB [4]. There is no systematic instrument developed to evaluate such perceptions in Indonesia. The Delphi technique is a useful approach to avoid conflicts in consensus where empirical data are scarce. Nominal group technique involving experts in the multidisciplinary panel to undertake repetitive measurements of content validity and avoid bias usually associated with group discussions [5]. In TB research, Delphi studies have successfully developed frameworks for behavioural outcome indicators, care matrices (e.g., for assessing TB health promotion outcomes), and differentiated TB care models [6-9] In Vietnam, comparable methods were employed to develop risk assessment tools for TB treatment interruption, illustrating the agility of the Delphi method across cultural and clinical settings [10]. In addition, research in China has developed a risk perception scale on respiratory infections with the help of Delphi-guided scale construction frame for long-term care facilities which also shows its value with an infection control instrument [11,12] In Indonesia, despite a number of studies that measured rates and risk factor for TB infection among HCWs, we identified an evident lacuna for the assessment of subjective risk perception and its behavioural antecedents [13,14] This is crucial since both mindsets on risk (perception) and prevention strategies are influenced by organizational and behavioral factors—i.e. workplace safety culture or stigma toward TB patients [15] This article is part of the CHART TB project, which seeks to remedy this by establishing an empirically driven Perceived Occupational Risk of TB (POR TB) questionnaire, trialled in community health centres and finalised through Delphi consensus. This procedure is consistent with recommendations for scale development, which specify moves from qualitative data to structured iterative agreement circles, establishing content validity [16] This is the first formal process for developing an occupational TB risk perception tool, namely among HCWs in Indonesia. The POR-TB questionnaire can be valuable for research and practice by integrating variables such as perceived risk, workplace security, stigma and knowledge. This could inform where intervention on IPC and behaviour change can be targeted. We consider that this testing instrument—emerging from the Delphi process and grounded in local trial evidence and international methods for health services research—will be valid and reliable, to then be ready for further psychometric validation before scaling up in health facilities with high TB burden in Indonesia--and potentially --other countries. Methodology The Delphi technique was developed by the RAND Corporation in the 1960s to assist a panel of experts in generating and reaching consensus on ideas [8]. It’s commonly used in behavioural research, occupational health and public health to develop standards, frameworks or survey instruments to validate [11,12]. This iterative feedback mechanism allows for anonymous responses by experts, structured feedback to those comments and subsequent revision of positions in further rounds. This minimizes the possibility of dictatorship by any one person and promotes unity in such an assembly. The Delphi method was chosen to explore, confirm and verify the POR-TB questionnaire as this study set out to improve and validate the tool. Research Tool and Data Collection The Delphi process started with Round 1, in which experts conducted question-based discussions through Google Meet. The purpose of this round was to generate an initial set of items for each domain, with initial input from the experts' practical experience in the field, as well as available literature and the requirements of NTP. The results of the discussion process, in conjunction with a review of existing instruments used to assess perceptions and knowledge on tuberculosis (TB), informed the construction of a draft questionnaire. The draft questionnaire was delivered to the same experts over the internet for the second round. The instrument was comprised of items measured on a 5-point Likert scale from "Strongly Disagree" (1) to "Strongly Agree" (5). Experts were asked to score each item on relevance and clarity, and provide qualitative feedback on how items should be modified, removed or added. Feedback from this round was analyzed quantitatively to find the percentage of experts rating each item as ≥4 (“Agree” or “Strongly Agree”—the consensus level being defined as 75%), thematic analysis of qualitative feedback and item refinement [8] Round 3 also saw another revised questionnaire sent to the expert panel. This round, the survey used all the changes suggested for Round 2. Again, the experts rated each statement and reached consensus on the revised framework and wording. Then we compared the average score and the percentage of people who agreed to see how much they agreed between Rounds 2 and 3. Those items that met or exceeded the criteria were retained. All Delphi rounds were conducted using an online format through Google Forms, which offered flexibility and minimized time pressures. Email and instant messaging reminders were used to increase response rates. Participants The rigorous identification of experts is a key step in implementing the Delphi method, since the validity, relevance and depth of its outcomes are dependent on these being competent and experienced [11]. The expert group for this investigation was selected specifically to allow the broadest range of relevant authorities with firsthand observations and practical experience in TB control, occupational health, and behavioural research. The goal was to develop TB prevention strategies in hospitals while collecting inputs from professionals working on developing, implementing, and evaluating patients with MDR- or pre-XDR TB, and researchers developing validation of psychometric instruments. The selection criteria for panel members were: (1) work experience of at least five years in fields related to tuberculosis program management, infection prevention and control, occupational health and safety, behavioral health or epidemiology; (2) excellent understanding of tuberculosis epidemiology and national tuberculosis control policy in Indonesia; (3) experience with development, modification or validation of health questionnaires; and (4) willingness to participate in all Delphi rounds within the time scheduled. Experts came from different professional backgrounds, including national tuberculosis control units, provincial and district health departments, psychiatrists and psychologists working in the hospitals or other facilities, faculty of medicine and public health, referral hospitals, as well as primary care service providers (Puskesmas). A purposive sampling strategy was applied to select 12 experts with high expertise in research, clinical management and occupational health of tuberculosis. Attendees were tuberculosis program managers, pulmonologists and public health researchers and lecturers at a university in infectious disease epidemiology. All experts had at least 10 years of practice and were involved in clinical or research activities on tuberculosis in Indonesia. The sample size was in line with the recommended range of the Delphi panel - it ranges from less than 10 to tens of participants depending on the research scope [5]. The high response rates for the total sample across all three rounds helped to reduce attrition bias and ensure consistent findings. Research Organisation The study included three rounds of the Delphi method to develop questionnaire items aimed at capturing healthcare workers’ perceptions of occupational risk and TB prevention, stigma in relation to TB, and knowledge about latent TB and pulmonary TB. According to Habibi et al. [5], consensus on an issue was considered to have been reached when 75% or more of the experts rated it as "Agree" (4) and/or "Strongly Agree" (5) using a 5-point Likert-type scale. Round 1: The purpose of Round 1 was to create a first set of items for each questionnaire domain based on expert knowledge and the relevant literature. This was carried out through a Google Meet virtual meeting with 12 TB experts (pulmonologists, TB program managers, occupational health specialists and public health researchers). Topics included stigma reduction, workplace protection and what healthcare professionals need to know about tuberculosis in two pages. Ultimately, by the completion of the session, a preliminary consensus was reached among the expert panel for identifying key domains and subdomains. This formed the foundation for the initial item pool. Round 2: The purpose for round two was to determine whether the opinions expressed in round one were relevant and easily understood. A structured questionnaire, comprising all prototype items was designed by the research team based on the results of the discussions and relevant literature. Items were rated on a five-point Likert scale (1 = Strongly Agree, 5 = Strongly Disagree). The survey was designed on Google Forms and took place online, using the platform because we believed it to be a readily available and frequent form of access. A total of 12 specialists returned the questionnaire within the given five days, achieving a 100% response. Quantitative analysis determined the percentage of agreement for each item, while qualitative feedback was used to revise the wording and format of some items. Statements showing <75% unanimity were subsequently modified. Round 3: The goal of Round 3 was to review the questionnaire and reach consensus among all experts on any modifications. The modified Round 2 questionnaire was distributed to the panel, showing all changes or modifications. Participants rated agreement with each question on a regular 5-point Likert scale. This round indicated that the expert consensus was consistent and that all items were in line with the set criteria beforehand. All 12 experts returned questionnaires, meaning all responded. No results were rejected, and the former domain configuration was kept. Results Table 1. Characteristics of Participants Characteristics Category Frequency % Gender Male 7 58.33% Female 5 41.67% Years of work 5–10 years 5 41.67% Over 10 years 7 58.33% Degree Master’s Degree Psychologist 8 2 66.67% Psychiatric Specialist 2 33.33% Workplace Hospital Primary Health Care 3 4 25.00% Academia 3 75.00% Table 1 describes the personal attributes of the 12 participants in Round 2. Among them, 7 (58.33%) were male and 5 (41.67%) were female. Most participants (58.33%) have more than 10 years of professional experience, indicating sufficient expertise in tuberculosis control, occupational health, and related public health fields. Concerning qualifications, 8 individuals (66.67%) possessed a master’s degree, while 4 individuals (33.33%) held a doctoral degree, indicating significant academic credentials. Nine individuals (75.00%) were affiliated with universities, whilst three individuals (25.00%) were employed by research agencies. All participants met the Delphi method criterion of possessing expertise in the research topic, so ensuring informed and relevant contributions to the consensus-building process. Table 2. Results of the Delphi Round 2 and Round 3 for Perceived TB Risk (PP01–PP09) No. Symbol Item Round 2 Mean SD % Consensus Round 3 Mean SD % Consensus 1 PP01 Perceived susceptibility to contracting TB at work 4.4 0.6 83.3% 4.6 0.5 91.7% 2 PP02 Risk from contact with undiagnosed TB patients 4.6 0.5 91.7% 4.7 0.5 100.0% 3 PP03 Risk during aerosol-generating procedures (e.g., sputum induction) 4.7 0.5 91.7% 4.8 0.4 100.0% 4 PP04 Risk in crowded or poorly ventilated clinical spaces 4.5 0.6 83.3% 4.6 0.5 91.7% 5 PP05 Risk when PPE is inconsistently available/used 4.2 0.7 75.0% 4.5 0.6 91.7% 6 PP06 Perceived risk of exposure to drug-resistant TB 4.3 0.7 75.0% 4.5 0.6 83.3% 7 PP07 Worry/anxiety about acquiring TB due to work 4.1 0.8 66.7% 4.4 0.6 83.3% 8 PP08 Perceived likelihood of infecting family from occupational exposure 4.2 0.7 75.0% 4.5 0.6 91.7% 9 PP09 Perceived personal control over avoiding TB exposure* 4.0 0.8 66.7% 4.3 0.6 83.3% Table 3. Results of the Delphi Round 2 and Round 3 for Workplace Safety (WS01–WS29) No. Symbol Item Round 2 Mean SD % Consensus Round 3 Mean SD % Consensus 1 WS01 Availability of N95 respirators 4.6 0.5 91.7% 4.7 0.5 100.0% 2 WS02 Fit-testing program implemented 4.4 0.6 83.3% 4.6 0.5 91.7% 3 WS03 Consistent mask use in TB areas 4.7 0.5 91.7% 4.8 0.4 100.0% 4 WS04 Hand hygiene adherence 4.5 0.6 83.3% 4.6 0.5 91.7% 5 WS05 Adequate ventilation (natural/mechanical) 4.3 0.7 75.0% 4.5 0.6 91.7% 6 WS06 Functional airborne isolation rooms 4.2 0.7 75.0% 4.4 0.6 83.3% 7 WS07 Triage of cough/suspect TB at entry 4.5 0.6 91.7% 4.6 0.5 100.0% 8 WS08 Prompt separation of TB suspects 4.1 0.8 66.7% 4.4 0.6 83.3% 9 WS09 Signage for respiratory hygiene 4.0 0.7 66.7% 4.3 0.6 83.3% 10 WS10 Availability of surgical masks for patients 4.2 0.7 75.0% 4.5 0.5 91.7% 11 WS11 Access to TB screening for staff 4.3 0.6 83.3% 4.5 0.5 91.7% 12 WS12 Periodic training on TB IPC 4.4 0.6 83.3% 4.6 0.5 100.0% 13 WS13 Administrative TB IPC policy exists 4.3 0.7 75.0% 4.5 0.6 91.7% 14 WS14 Monitoring & audit of IPC practices 4.1 0.8 66.7% 4.4 0.6 83.3% 15 WS15 Adequate PPE stock management 4.2 0.7 75.0% 4.5 0.5 91.7% 16 WS16 Waste management and disposal 4.3 0.7 75.0% 4.5 0.6 91.7% 17 WS17 UVGI or air-cleaning devices maintained 4.0 0.8 66.7% 4.3 0.6 83.3% 18 WS18 Patient flow reduces crowding 4.1 0.7 66.7% 4.4 0.6 83.3% 19 WS19 Respiratory etiquette promoted 4.2 0.7 75.0% 4.4 0.6 83.3% 20 WS20 HCW vaccination & health checks 4.3 0.6 83.3% 4.4 0.6 91.7% 21 WS21 Rapid diagnostic access for TB 4.5 0.6 91.7% 4.6 0.5 100.0% 22 WS22 Safe sputum collection areas 4.2 0.7 75.0% 4.4 0.6 91.7% 23 WS23 Staff compliance with isolation protocols 4.4 0.6 83.3% 4.6 0.5 100.0% 24 WS24 Management support for TB IPC 4.3 0.7 75.0% 4.5 0.6 91.7% 25 WS25 Incident reporting & feedback loop 4.1 0.7 66.7% 4.3 0.6 83.3% 26 WS26 Availability of respirator reuse policy 4.0 0.8 66.7% 4.3 0.6 83.3% 27 WS27 Clear TB IPC roles & responsibilities 4.2 0.7 75.0% 4.5 0.5 91.7% 28 WS28 Routine risk assessment of TB exposure 4.3 0.6 83.3% 4.5 0.5 91.7% 29 WS29 Availability of TB IPC job aids/posters 4.1 0.7 66.7% 4.4 0.6 83.3% Table 4. Results of the Delphi Round 2 and Round 3 for TB-Related Stigma (E1–E7) No. Symbol Item Round 2 Mean SD % Consensus Round 3 Mean SD % Consensus 1 E1 People with TB are often treated with less respect 4.3 0.6 83.3% 4.5 0.5 91.7% 2 E2 People with TB tend to hide their diagnosis to avoid discrimination 4.5 0.5 91.7% 4.6 0.5 100.0% 3 E3 Having TB can lead to people avoiding the patient 4.4 0.6 83.3% 4.5 0.5 91.7% 4 E4 People with TB may lose their job or source of income 4.2 0.7 75.0% 4.4 0.6 83.3% 5 E5 People with TB often feel ashamed because of the disease 4.3 0.6 83.3% 4.5 0.5 91.7% 6 E6 Friends and family may distance themselves from a person with TB 4.1 0.7 75.0% 4.3 0.6 83.3% 7 E7 TB stigma discourages people from seeking timely treatment 4.5 0.5 91.7% 4.6 0.5 100.0% Table 5. Results of the Delphi Round 2 and Round 3 for Latent TB Knowledge (F1–F6) No. Symbol Item Round 2 Mean SD % Consensus Round 3 Mean SD % Consensus 1 F1 Latent TB infection means a person has TB bacteria but no symptoms 4.6 0.5 91.7% 4.7 0.5 100.0% 2 F2 People with latent TB can spread TB bacteria to others 4.4 0.5 83.3% 4.5 0.5 91.7% 3 F3 People with latent TB usually feel healthy 4.3 0.6 83.3% 4.5 0.5 91.7% 4 F4 People with latent TB should take preventive treatment to avoid active TB 4.5 0.5 91.7% 4.6 0.5 100.0% 5 F5 Without treatment, latent TB can progress to active TB 4.6 0.5 91.7% 4.7 0.5 100.0% 6 F6 BCG vaccination prevents latent TB infection 4.2 0.7 75.0% 4.4 0.6 83.3% Table 6. Results of the Delphi Round 2 and Round 3 for Pulmonary TB Knowledge (G1–G11) No. Symbol Item Round 2 Mean SD % Consensus Round 3 Mean SD % Consensus 1 G1 Pulmonary TB is caused by Mycobacterium tuberculosis 4.8 0.4 100.0% 4.8 0.4 100.0% 2 G2 Pulmonary TB can be transmitted through coughing, sneezing, or speaking 4.7 0.5 100.0% 4.8 0.4 100.0% 3 G3 TB transmission occurs via sharing food or utensils 4.2 0.7 75.0% 4.4 0.6 83.3% 4 G4 People with pulmonary TB always have a cough lasting more than two weeks 4.3 0.6 83.3% 4.5 0.5 91.7% 5 G5 Pulmonary TB symptoms can include weight loss, night sweats, and fever 4.6 0.5 91.7% 4.7 0.5 100.0% 6 G6 Pulmonary TB can only be diagnosed with a chest X-ray 4.1 0.7 75.0% 4.3 0.6 83.3% 7 G7 Sputum examination is an important test for pulmonary TB diagnosis 4.7 0.5 100.0% 4.8 0.4 100.0% 8 G8 Pulmonary TB can be completely cured with appropriate treatment 4.8 0.4 100.0% 4.8 0.4 100.0% 9 G9 TB patients must complete their full course of treatment even if symptoms disappear 4.8 0.4 100.0% 4.9 0.3 100.0% 10 G10 Multi-drug resistant TB occurs when TB bacteria become resistant to at least isoniazid and rifampicin 4.6 0.5 91.7% 4.7 0.5 100.0% 11 G11 BCG vaccination provides lifelong protection against pulmonary TB 4.2 0.7 75.0% 4.3 0.6 83.3% In Table 2, Across five specific domains (perceived TB risk in the workplace (PP01–PP09), Table 3 workplace safety (WS01–WS29), Table 4 TB-related stigma (E1–E7), table 5 knowledge about latent TB [F1–F6] and table 6 knowledge about pulmonary TB [G1–11]), the Delphi process indicated a high degree of expert agreement concerning most items in Round 3, which reached or exceeded the 75% consensus. The highest-level consensus of the PP field was about direct patient contact and infectious aerosol exposure; questions on indirect exposure faced a lower-level agreement before modification. The WS domain had general agreement in terms of the importance given to infection control measures, supply of PPE, and safety rules at the institution; on the other hand, there was initially much variability among its items that are related to administrative enforcement. It is widely believed among the experts that organisational culture, colleagues' attitudes and institutional support are crucial to reducing TB-related stigma (domain E). There is an increasing common ground that leadership needs to be part of this work. F (latent TB) and G (pulmonary TB Knowledge) is almost always very similar for the knowledge items, such as knowing how TB is diagnosed and treated. Some thought that receiving the BCG vaccine would give them lifelong immunity or that an X-ray of their chest would be enough for diagnosis. People didn’t agree with these ideas at first, but they grew better when the items were on paper because they were more transparent. The items became much clearer and closer to what experts agreed on after the Delphi rounds. This resulted in a complete questionnaire that addressed the potentially important categories. Figure 1 illustrates the incremental process that was used to form a consensus in this Delphi study, and shows how questionnaire items were systematically revised through expert involvement. It illustrates how the research evolved from initial item generation to repeated expert rating, as with each iteration clarity/certainty increased until stability. The incremental process of development highlights transparency in which the expert feedback guided the portion towards the stepwise, and it provides information on how all steps led to the final POR-TB, adding scientific robustness and contextual applicability for TB risk among HCWs from an occupational standpoint. The Round 3 questionnaire included all elements of content from the five domains – perceived occupational TB risk (PP01–PP09), health and safety climate (WS01–WS29), stigma (E1–E7), knowledge of LTBI (F1–F6) and knowledge about PTB (G1– G11) – that had been refined following feedback elicited in Round 2. All 12 Round-2 experts were invited to participate in Round 3, and all accepted the invitation, resulting in a 100% response rate. In Round 3, the lack of consent could have come from <75% in at least four out of five domains. Nevertheless, 90% agreement is what most of the items wind up getting. This indicates that the majority of experts from the panel agree on how clear, relevant and important each questionnaire item is. This demonstrates that the final instrument is reliable and has content validity. Discussion Delphi study results There was a high consensus among experts on the core domains and items to assess HCWs’ perception of TB risk at the workplace, safety in the work environment, stigma, and TB referral knowledge. In the perception of occupational risk for TB (PP01–PP09) field, all items exceeded the consensus threshold, reflecting consensus about the importance of evaluating healthcare worker recognition about their personal risks for exposure to TB in clinical settings. This is consistent with previous evidence that the risk perception plays an important role in preventive behavior of healthcare worker and adherence to infection prevention and control (IPC) measures [17-20]. The addition of items concerning patient contact and environmental exposure gives a fuller picture of identified risks for tuberculosis in the hospital. In the workplace safety sector (WS01–WS29), assessing the safety culture was emphasized to be crucial and must include management support, IPC training, PPE, and enough ventilation. Results suggest that the organisational commitment to safety in the workplace would have a direct effect on tuberculosis transmission risk at HCWs [21-25]. There is also agreement on the need for ongoing safety training and periodic risk assessment, which aligns with guidance on health worker protection in high-burden settings outlined in WHO’s 2023 Global TB Report [1]. The broad item sampling curve ensures that the scale cuts both physical resources and safety-related behaviors. There was agreement on all the items within the TB-related stigma area (E1–E7), which indicates that there is still an understanding of stigma towards persons with TB in HCWs. Stigmatisation leads to low patient trust, low care-seeking and low treatment compliance [26-29] This area involves attitudes and behaviors associated with the stigma domain, corresponding to current theoretical frameworks that separate enacted, perceived and internalized stigma [30-33]. The consensus of experts highlights the need for TB programs for HCWs to integrate stigma-reduction interventions [34-35] The latent TB domain (F1–F6) observed high concurrence in the items measuring perceptions of TB infection versus active disease, risk of transmission, and procedures associated with preventive therapy. This is in line with studies showing that among HCWs, often knowledge gaps on LTBI are present, leading to underdiagnosis and missed prevention opportunities [36-37]. Inclusion of knowledge-based questions is even more important in Indonesia, where the burden and exposure risk among health care workers is high [24]. Adequate competency in LTBI management harmonizes with the End TB Strategy targets on coverage of preventive treatment. All questions in the pulmonary TB (G1–G11) knowledge domain showed high consensus, indicating that the panel could agree on the importance of biomedical knowledge for tuberculosis control. Sources relating to signs and symptoms of TB, transmission, diagnostic modality, and treatment protocols are consistent with the World Health Organisation (WHO) global tuberculosis competencies for healthcare workers [36]. Previous evidence shows that limited tuberculosis knowledge among health care workers is related with delay in diagnosis, and suboptimal treatment initiation [37-38] therefore clearly indicating the importance of this dimension in the questionnaire. The incorporation of the perceived risk (PP) and workplace safety (WS) dimensions addresses the interactions between individual cognition and structural workplace factors. Studies in occupational health suggest that risk perception on its own may not be enough to encourage protective behaviour, unless the environment and organisational support mechanisms are in place [39]. The high degree of agreement in either category is suggestive of how the expert panel considers these two categories to be interconnected, and supports an overarching approach to assessment, recognising both psychosocial and systems-related factors affecting TB preventive behaviour. There is broad professional agreement that TB health care workers’ attitudes have an influence on infection control measures and patient involvement. Fear-driven fears have been related to increased quarantine measures and avoidance of patient contact, although this might ironically affect the quality of care [40] Focused education and infrastructure modifications could increase compliance with IPC, resulting in improved patient-centred care. The domains of knowledge (F and G) contribute to the perception and safety domains by providing an objective assessment of TB-specific skills. Changing TB epidemiology, such as that posed by multidrug-resistant TB and the inclusion of preventive therapy, demands that healthcare workers remain educated [41] These consistencies between the fields are consistent with the panel's assertion that knowledge assessment should be incorporated into occupational TB risk screening instruments. This study used the Delphi technique to verify that the questions included in a final tool were evidence-based and contextually relevant to tuberculosis burden and healthcare system for Indonesia. Previous TB risk assessment instruments developed in other settings have faced challenges when adapted to another cultural context [13-15]. Nevertheless, the iterative consensus method used in this study enabled us to tailor items to local epidemiological and occupational contexts. This increases likelihood of their adoption and application in practical tuberculosis control programs. There is strong consensus across all domains meaning that the final instrument has good content validity and anticipated acceptability among HCWs and TB programme implementers. The instrument provides a holistic model of assessing health care worker readiness for occupational TB transmission by targeting perceived risk, safety issues in the workplace, stigma, and knowledge of both latent and active TB. Further research should be directed towards psychometric validation, in particular construct validity and reliability assessment and predictive validity with real IPC behaviour in healthcare. Conclusion Twelve experts achieved consensus using a three-round Delphi method to construct a 63-item questionnaire for measuring Perceived Occupational Risk of Tuberculosis (POR-TB). The questionnaire asked about five topics: whether you think that you will get tuberculosis, how safe you think your workplace is, how much you know about latent tuberculosis, and also pulmonary (lung) tuberculosis knowledge. The tool is locally relevant to evaluate infection prevention and control practices of HCWs within the Indonesian workplace and can be used for context-targeted direction regarding ethical, scientific policy approaches and research planning. The Delphi approach allows in-depth input from experts and provides consensus but does not quantify specific items on the basis of importance or predictive efficiency. Next studies should be directed to the psychometric validation, either with HCWs in different provinces, and a higher sample size or different types of validity values using EFA/CFA and SEM techniques to establish the construct validity, reliability levels, and structural domain of the POR-TB questionnaire. Declarations Ethics approval This study was reviewed and approved by the Health Research Ethics Committee (Komite Etik Penelitian Kesehatan) of the Faculty of Medicine, Universitas Tanjungpura, Indonesia. Participant consent All participants were adult healthcare workers who provided informed consent prior to participation. Consent was obtained electronically via the online Delphi survey; participation was voluntary and responses were anonymized. No patient data were collected, and consent to publish aggregated, de-identified results was obtained. Acknowledgment These study was funded by a grant from the Royal Society of Tropical Medicine and Hygiene (RSTMH) and from the National Institutes of Health (NIH). All experts who participated in the Delphi rounds and provided feedback for the development of the POR-TB are gratefully acknowledged by the authors. References World Health Organization. (2023). Global Tuberculosis Report 2023 . Geneva: WHO . 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The Delphi Method: Techniques and Applications . Reading, MA: Addison-Wesley. Gordon, T. J. (2003). The Delphi method. In Foresight , the handbook (pp. 56–66). Washington: United States Government. McKenna, H. P. (1994). The Delphi technique: a worthwhile research approach for nursing? Journal of Advanced Nursing , 19(6), 1221–1225. Irvine, D. J. (2005). Delphi--not just for experts? Journal of Clinical Nursing , 14(8), 965–975. Mori, R.; Shiratani, K. Developing Risk Assessment Items of Treatment Interruption Among Vietnamese Patients with Tuberculosis in Japanese DOTS—A Quantitative and Qualitative Survey Using the Delphi Method. Nurs. Rep. 2024, 14, 3310–3327. https://doi.org/10.3390/nursrep14040240 Li, Y., Ehiri, J., Hu, D. et al. Framework of behavioural indicators for outcome evaluation of TB health promotion: a Delphi study of TB suspects and TB patients. BMC Infect Dis 14 , 268 (2014). https://doi.org/10.1186/1471-2334-14-268 Keeney S, Hasson F, McKenna H. Consulting the oracle: ten lessons from using the Delphi technique in nursing research. J Adv Nurs. 2006 Jan;53(2):205-12. doi: 10.1111/j.1365-2648.2006.03716.x. PMID: 16422719 Harries AD, Maher D, Nunn P. Practical and affordable measures for the protection of health care workers from tuberculosis in low-income countries. Bull World Health Organ. 1997;75(5):477-89. PMID: 9447782; PMCID: PMC2487014. Zein, Rizqy Amelia. Ratna Dwi Wulandari, Ilham Akhsanu Ridlo et al. The characteristics of occupational tuberculosis risk in healthcare workers. Int J Health Plann Mgmt. 2022;37:2669–2683. wileyonlinelibrary.com/journal/hpm. DOI: 10.1002/hpm.3489 Felisia F, Triasih R, Nababan BWY, Sanjaya GY, Dewi SC, Rahayu ES, Unwanah L, du Cros P, Chan G. High Tuberculosis Preventive Treatment Uptake and Completion Rates Using a Person-Centered Approach among Tuberculosis Household Contact in Yogyakarta. Trop Med Infect Dis. 2023 Dec 14;8(12):520. doi: 10.3390/tropicalmed8120520. PMID: 38133452; PMCID: PMC10747839. Xie Z, Zhu J, Xie X, Huang L, Ren J, Martin-Payo R, Qiu M and Zhang F (2025) Development and validation of a risk perception scale on acute respiratory infections for caregivers in long-term care facilities. Front. Public Health 13:1527905.doi: 10.3389/fpubh.2025.1527905 Lee S, Lee W, Kang SK. Tuberculosis infection status and risk factors among health workers: an updated systematic review. Ann Occup Environ Med. 2021 May 28;33:e17. doi: 10.35371/aoem.2021.33.e17. PMID: 34754478; PMCID: PMC8205617. Uden L, Barber E, Ford N, Cooke GS. Risk of Tuberculosis Infection and Disease for Health Care Workers: An Updated Meta-Analysis. Open Forum Infect Dis. 2017 Aug 29;4(3):ofx137. doi: 10.1093/ofid/ofx137. PMID: 28875155; PMCID: PMC5575844. Somma D, Thomas BE, Karim F, Kemp J, Arias N, Auer C, Gosoniu GD, Abouihia A, Weiss MG. Gender and socio-cultural determinants of TB-related stigma in Bangladesh, India, Malawi and Colombia. Int J Tuberc Lung Dis. 2008 Jul;12(7):856-66. PMID: 18544216. Courtwright A, Turner AN. Tuberculosis and stigmatization: pathways and interventions. Public Health Rep. 2010 Jul-Aug;125 Suppl 4(Suppl 4):34-42. doi: 10.1177/00333549101250S407. PMID: 20626191; PMCID: PMC2882973. Chang SH, Cataldo JK. A systematic review of global cultural variations in knowledge, attitudes and health responses to tuberculosis stigma. Int J Tuberc Lung Dis. 2014 Feb;18(2):168-73, i-iv. doi: 10.5588/ijtld.13.0181. PMID: 24429308. Getahun H, Matteelli A, Abubakar I et al. Management of latent Mycobacterium tuberculosis infection: WHO guidelines for low tuberculosis burden countries. Eur Respir J. 2015 Dec;46(6):1563-76. doi: 10.1183/13993003.01245-2015. Epub 2015 Sep 24. PMID: 26405286; PMCID: PMC4664608. Alsdurf H, Hill PC, Matteelli A, Getahun H, Menzies D. The cascade of care in diagnosis and treatment of latent tuberculosis infection: a systematic review and meta-analysis. Lancet Infect Dis. 2016 Nov;16(11):1269-1278. doi: 10.1016/S1473-3099(16)30216-X. Epub 2016 Aug 10. PMID: 27522233. Ministry of Health Indonesia. (2022). Indonesia National TB Prevalence Survey Report . Jakarta: MOH. Main S, Dwihardiani B, Hidayat A, Khodijah S, Greig J, Chan G, Parry AE, Nababan B, Billy I, du Cros P, Triasih R. Knowledge and attitudes towards TB among healthcare workers in Yogyakarta, Indonesia. Public Health Action. 2022 Sep 21;12(3):133-140. doi: 10.5588/pha.22.0017. PMID: 36160721; PMCID: PMC9484592. Fan M, Liu Y, Liu K, Liu X, Li Y, Li T, Zhang C, Zhang H, Cheng J. Health system delay and risk factors in pulmonary tuberculosis diagnosis before and during the COVID-19 epidemic: a multi-center survey in China. Front Public Health. 2025 Feb 26;13:1526774. doi: 10.3389/fpubh.2025.1526774. PMID: 40078758; PMCID: PMC11896862. Buregyeya E, Kasasa S, Mitchell EM. Tuberculosis infection control knowledge and attitudes among health workers in Uganda: a cross-sectional study. BMC Infect Dis. 2016 Aug 15;16(1):416. doi: 10.1186/s12879-016-1740-7. PMID: 27526850; PMCID: PMC4986352. Myburgh H, Kaur M, Kaur P, Santos V, Almeida C, Hoddinott G, Wademan DT, Lakshmi PVM, Osman M, Meehan SA, Hesseling AC, Purty A, Singh UB, Trajman A. Lessons for TB from the COVID-19 response: qualitative data from Brazil, India and South Africa. Public Health Action. 2023 Dec;13(4):162-168. doi: 10.5588/pha.23.0044. Epub 2023 Dec 7. PMID: 38077722; PMCID: PMC10703135. Dheda K, Pinto L, Mutsvangwa J, Leung CC, von Delft A, Ruhwald M. Accelerate investment and action to find the missing patients with tuberculosis. Lancet. 2022 Jun 4;399(10341):2086-2088. doi: 10.1016/S0140-6736(22)00535-9. Epub 2022 Mar 22. PMID: 35334210; PMCID: PMC8940183. Lönnroth K, Jaramillo E, Williams BG, Dye C, Raviglione M. Drivers of tuberculosis epidemics: the role of risk factors and social determinants. Soc Sci Med. 2009 Jun;68(12):2240-6. doi: 10.1016/j.socscimed.2009.03.041. Epub 2009 Apr 23. PMID: 19394122. Menzies D, Joshi R, Pai M. Risk of tuberculosis infection and disease associated with work in health care settings. Int J Tuberc Lung Dis. 2007 Jun;11(6):593-605. PMID: 17519089. Gottesfeld P. Preventing Tuberculosis (TB) in health workers and silica-exposed occupations. Saf Health Work. 2022 Jan;13:S6–7. doi: 10.1016/j.shaw.2021.12.721. Epub 2022 Feb 5. PMCID: PMC8817354. van der Westhuizen HM, Dorward J, Roberts N, Greenhalgh T, Ehrlich R, Butler CC, Tonkin-Crine S. Health worker experiences of implementing TB infection prevention and control: A qualitative evidence synthesis to inform implementation recommendations. PLOS Glob Public Health. 2022 Jul 7;2(7):e0000292. doi: 10.1371/journal.pgph.0000292. PMID: 36962407; PMCID: PMC10021216. Sartika I, Insani WN, Abdulah R. Assessment of Health-Related Quality of Life among Tuberculosis Patients in a Public Primary Care Facility in Indonesia. J Glob Infect Dis. 2019 Jul-Sep;11(3):102-106. doi: 10.4103/jgid.jgid_136_18. PMID: 31543651; PMCID: PMC6733192. Bodur MS, Çil B. A Research on Healthcare Professionals’ Stigma Towards Tuberculosis Patients. Thorac Res Pract. 2025 Apr 30;26(3):88-96. doi: 10.4274/ThoracResPract.2024.24079. Epub 2025 Jan 27. PMID: 39930730; PMCID: PMC12047200. Chen, X., Du, L., Wu, R. et al. Tuberculosis-related stigma and its determinants in Dalian, Northeast China: a cross-sectional study. BMC Public Health 21 , 6 (2021). https://doi.org/10.1186/s12889-020-10055-2 Sridevi NH, & Nandini C. (2019). Knowledge, Attitude and Practices on Tuberculosis Infection Control among Health Workers in Shivamogga. National Journal of Community Medicine , 10 (11), 575–578. Retrieved from https://njcmindia.com/index.php/file/article/view/571. Cherkaoui I, Sabouni R, Ghali I, Kizub D, Billioux AC, Bennani K, et al. (2014) Treatment Default amongst Patients with Tuberculosis in Urban Morocco: Predicting and Explaining Default and Post-Default Sputum Smear and Drug Susceptibility Results. PLoS ONE 9(4): e93574. https://doi.org/10.1371/journal.pone.0093574 WHO. (2021). WHO policy on TB infection prevention and control in healthcare settings .Geneva: World Health Organization. Zhang J, Zhou X, Wang H, Luo Y, Li W. Development and Validation of the Humanistic Practice Ability of Nursing Scale. Asian Nurs Res (Korean Soc Nurs Sci). 2021 May;15(2):105-112. doi: 10.1016/j.anr.2020.12.003. Epub 2021 Jan 14. PMID: 33453453.. Chitu Okoli, Suzanne D. Pawlowski, The Delphi method as a research tool: an example, design considerations and applications, Information & Management, Volume 42, Issue 1, 2004, Pages 15-29, ISSN 0378-7206, https://doi.org/10.1016/j.im.2003.11.002 Additional Declarations No competing interests reported. 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1","display":"","copyAsset":false,"role":"figure","size":27856,"visible":true,"origin":"","legend":"\u003cp\u003eThe results of the Delphi Panel\u003c/p\u003e","description":"","filename":"Picture1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7763696/v1/3ccc39b6a77131d85fd171d6.jpg"},{"id":98813994,"identity":"f51d7e13-0e4c-4d08-bfae-fd7b1a925a2a","added_by":"auto","created_at":"2025-12-22 16:09:11","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1097487,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7763696/v1/ba636d1c-8ec8-4372-a0a6-febbb06adecc.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Establishing Consensus of Perceived Occupational Risk of Tuberculosis (POR-TB) Among Healthcare Workers: A Delphi Study in Indonesia","fulltext":[{"header":"Introduction","content":"\u003cp\u003eTuberculosis (TB) remains an important occupational hazard for healthcare workers (HCWs), particularly in high burden countries, including Indonesia, where exposure to undiagnosed TB cases and as it occurs, HCWs are highly prevalent in clinical settings [1]. The available evidence since suggests that nosocomial transmission and infection control deficiencies considerably raise the risk of TB in HCWs, with some studies reporting rates of Latent Tuberculosis Infection (LTBI) over 25% in primary care staff [2]. Health care protective practices and compliance with preventive measures depend on risk perception. Yet, the local situation in a regional setting, as in Indonesia, is less understood [3]\u003c/p\u003e\n\u003cp\u003ePerceived occupational risks, for example, perceived severity, vulnerability, control and emotional distress, are psychological constructs that affect how healthcare workers perceive and react to the dangers of tuberculosis. One research with structural equation modelling (SEM) found that perceived beliefs of feasibility in controlling situations may play an even more important role than perception of threat in risk taking. This indicates that interventions need to enhance personal efficacy about preventing exposure to TB [4]. There is no systematic instrument developed to evaluate such perceptions in Indonesia.\u003c/p\u003e\n\u003cp\u003eThe Delphi technique is a useful approach to avoid conflicts in consensus where empirical data are scarce. Nominal group technique involving experts in the multidisciplinary panel to undertake repetitive measurements of content validity and avoid bias usually associated with group discussions [5]. In TB research, Delphi studies have successfully developed frameworks for behavioural outcome indicators, care matrices (e.g., for assessing TB health promotion outcomes), and differentiated TB care models [6-9]\u003c/p\u003e\n\u003cp\u003eIn Vietnam, comparable methods were employed to develop risk assessment tools for TB treatment interruption, illustrating the agility of the Delphi method across cultural and clinical settings [10]. In addition, research in China has developed a risk perception scale on respiratory infections with the help of Delphi-guided scale construction frame for long-term care facilities which also shows its value with an infection control instrument [11,12]\u003c/p\u003e\n\u003cp\u003eIn Indonesia, despite a number of studies that measured rates and risk factor for TB infection among HCWs, we identified an evident lacuna for the assessment of subjective risk perception and its behavioural antecedents [13,14] This is crucial since both mindsets on risk (perception) and prevention strategies are influenced by organizational and behavioral factors—i.e. workplace safety culture or stigma toward TB patients [15]\u003c/p\u003e\n\u003cp\u003eThis article is part of the CHART TB project, which seeks to remedy this by establishing an empirically driven Perceived Occupational Risk of TB (POR TB) questionnaire, trialled in community health centres and finalised through Delphi consensus. This procedure is consistent with recommendations for scale development, which specify moves from qualitative data to structured iterative agreement circles, establishing content validity [16]\u003c/p\u003e\n\u003cp\u003eThis is the first formal process for developing an occupational TB risk perception tool, namely among HCWs in Indonesia. The POR-TB questionnaire can be valuable for research and practice by integrating variables such as perceived risk, workplace security, stigma and knowledge. This could inform where intervention on IPC and behaviour change can be targeted.\u003c/p\u003e\n\u003cp\u003eWe consider that this testing instrument—emerging from the Delphi process and grounded in local trial evidence and international methods for health services research—will be valid and reliable, to then be ready for further psychometric validation before scaling up in health facilities with high TB burden in Indonesia--and potentially --other countries.\u003c/p\u003e"},{"header":"Methodology","content":"\u003cp\u003eThe Delphi technique was developed by the RAND Corporation in the 1960s to assist a panel of experts in generating and reaching consensus on ideas [8]. It’s commonly used in behavioural research, occupational health and public health to develop standards, frameworks or survey instruments to validate [11,12]. This iterative feedback mechanism allows for anonymous responses by experts, structured feedback to those comments and subsequent revision of positions in further rounds. This minimizes the possibility of dictatorship by any one person and promotes unity in such an assembly. The Delphi method was chosen to explore, confirm and verify the POR-TB questionnaire as this study set out to improve and validate the tool.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eResearch Tool and Data Collection\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe Delphi process started with Round 1, in which experts conducted question-based discussions through Google Meet. The purpose of this round was to generate an initial set of items for each domain, with initial input from the experts' practical experience in the field, as well as available literature and the requirements of NTP. The results of the discussion process, in conjunction with a review of existing instruments used to assess perceptions and knowledge on tuberculosis (TB), informed the construction of a draft questionnaire.\u003c/p\u003e\n\u003cp\u003eThe draft questionnaire was delivered to the same experts over the internet for the second round. The instrument was comprised of items measured on a 5-point Likert scale from \"Strongly Disagree\" (1) to \"Strongly Agree\" (5). Experts were asked to score each item on relevance and clarity, and provide qualitative feedback on how items should be modified, removed or added. Feedback from this round was analyzed quantitatively to find the percentage of experts rating each item as ≥4 (“Agree” or “Strongly Agree”—the consensus level being defined as 75%), thematic analysis of qualitative feedback and item refinement [8]\u003c/p\u003e\n\u003cp\u003eRound 3 also saw another revised questionnaire sent to the expert panel. This round, the survey used all the changes suggested for Round 2. Again, the experts rated each statement and reached consensus on the revised framework and wording. Then we compared the average score and the percentage of people who agreed to see how much they agreed between Rounds 2 and 3. Those items that met or exceeded the criteria were retained.\u003c/p\u003e\n\u003cp\u003eAll Delphi rounds were conducted using an online format through Google Forms, which offered flexibility and minimized time pressures. Email and instant messaging reminders were used to increase response rates.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eParticipants\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe rigorous identification of experts is a key step in implementing the Delphi method, since the validity, relevance and depth of its outcomes are dependent on these being competent and experienced [11]. The expert group for this investigation was selected specifically to allow the broadest range of relevant authorities with firsthand observations and practical experience in TB control, occupational health, and behavioural research. The goal was to develop TB prevention strategies in hospitals while collecting inputs from professionals working on developing, implementing, and evaluating patients with MDR- or pre-XDR TB, and researchers developing validation of psychometric instruments.\u003c/p\u003e\n\u003cp\u003eThe selection criteria for panel members were: (1) work experience of at least five years in fields related to tuberculosis program management, infection prevention and control, occupational health and safety, behavioral health or epidemiology; (2) excellent understanding of tuberculosis epidemiology and national tuberculosis control policy in Indonesia; (3) experience with development, modification or validation of health questionnaires; and (4) willingness to participate in all Delphi rounds within the time scheduled. Experts came from different professional backgrounds, including national tuberculosis control units, provincial and district health departments, psychiatrists and psychologists working in the hospitals or other facilities, faculty of medicine and public health, referral hospitals, as well as primary care service providers (Puskesmas).\u003c/p\u003e\n\u003cp\u003eA purposive sampling strategy was applied to select 12 experts with high expertise in research, clinical management and occupational health of tuberculosis. Attendees were tuberculosis program managers, pulmonologists and public health researchers and lecturers at a university in infectious disease epidemiology. All experts had at least 10 years of practice and were involved in clinical or research activities on tuberculosis in Indonesia. The sample size was in line with the recommended range of the Delphi panel - it ranges from less than 10 to tens of participants depending on the research scope [5]. The high response rates for the total sample across all three rounds helped to reduce attrition bias and ensure consistent findings.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eResearch Organisation\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe study included three rounds of the Delphi method to develop questionnaire items aimed at capturing healthcare workers’ perceptions of occupational risk and TB prevention, stigma in relation to TB, and knowledge about latent TB and pulmonary TB. According to Habibi et al. [5], consensus on an issue was considered to have been reached when 75% or more of the experts rated it as \"Agree\" (4) and/or \"Strongly Agree\" (5) using a 5-point Likert-type scale.\u003c/p\u003e\n\u003cp\u003eRound 1:\u003c/p\u003e\n\u003cp\u003eThe purpose of Round 1 was to create a first set of items for each questionnaire domain based on expert knowledge and the relevant literature. This was carried out through a Google Meet virtual meeting with 12 TB experts (pulmonologists, TB program managers, occupational health specialists and public health researchers). Topics included stigma reduction, workplace protection and what healthcare professionals need to know about tuberculosis in two pages. Ultimately, by the completion of the session, a preliminary consensus was reached among the expert panel for identifying key domains and subdomains. This formed the foundation for the initial item pool.\u003c/p\u003e\n\u003cp\u003eRound 2:\u003c/p\u003e\n\u003cp\u003eThe purpose for round two was to determine whether the opinions expressed in round one were relevant and easily understood. A structured questionnaire, comprising all prototype items was designed by the research team based on the results of the discussions and relevant literature. Items were rated on a five-point Likert scale (1 = Strongly Agree, 5 = Strongly Disagree). The survey was designed on Google Forms and took place online, using the platform because we believed it to be a readily available and frequent form of access. A total of 12 specialists returned the questionnaire within the given five days, achieving a 100% response. Quantitative analysis determined the percentage of agreement for each item, while qualitative feedback was used to revise the wording and format of some items. Statements showing \u0026lt;75% unanimity were subsequently modified.\u003c/p\u003e\n\u003cp\u003eRound 3:\u003c/p\u003e\n\u003cp\u003eThe goal of Round 3 was to review the questionnaire and reach consensus among all experts on any modifications. The modified Round 2 questionnaire was distributed to the panel, showing all changes or modifications. Participants rated agreement with each question on a regular 5-point Likert scale. This round indicated that the expert consensus was consistent and that all items were in line with the set criteria beforehand. All 12 experts returned questionnaires, meaning all responded. No results were rejected, and the former domain configuration was kept.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eTable 1. Characteristics of Participants\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable border=\"1\" cellspacing=\"3\" cellpadding=\"0\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eCharacteristics\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eCategory\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e58.33%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e41.67%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eYears of work\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e5\u0026ndash;10 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e41.67%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eOver 10 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e58.33%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eDegree\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eMaster\u0026rsquo;s Degree\u003c/p\u003e\n \u003cp\u003ePsychologist\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e66.67%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003ePsychiatric Specialist\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e33.33%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eWorkplace\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eHospital\u003c/p\u003e\n \u003cp\u003ePrimary Health Care\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e25.00%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eAcademia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e75.00%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eTable 1 describes the personal attributes of the 12 participants in Round 2. Among them, 7 (58.33%) were male and 5 (41.67%) were female. Most participants (58.33%) have more than 10 years of professional experience, indicating sufficient expertise in tuberculosis control, occupational health, and related public health fields. Concerning qualifications, 8 individuals (66.67%) possessed a master\u0026rsquo;s degree, while 4 individuals (33.33%) held a doctoral degree, indicating significant academic credentials. Nine individuals (75.00%) were affiliated with universities, whilst three individuals (25.00%) were employed by research agencies. All participants met the Delphi method criterion of possessing expertise in the research topic, so ensuring informed and relevant contributions to the consensus-building process.\u003c/p\u003e\n\u003cp\u003eTable 2. Results of the Delphi Round 2 and Round 3 for Perceived TB Risk (PP01\u0026ndash;PP09)\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"3\" cellpadding=\"0\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eNo.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eSymbol\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eItem\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eRound 2 Mean\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eSD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e% Consensus\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eRound 3 Mean\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eSD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e% Consensus\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003ePP01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003ePerceived susceptibility to contracting TB at work\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e83.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e91.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003ePP02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eRisk from contact with undiagnosed TB patients\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e91.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e100.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003ePP03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eRisk during aerosol-generating procedures (e.g., sputum induction)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e91.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e100.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003ePP04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eRisk in crowded or poorly ventilated clinical spaces\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e83.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e91.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003ePP05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eRisk when PPE is inconsistently available/used\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e75.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e91.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003ePP06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003ePerceived risk of exposure to drug-resistant TB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e75.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e83.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003ePP07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eWorry/anxiety about acquiring TB due to work\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e66.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e83.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003ePP08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003ePerceived likelihood of infecting family from occupational exposure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e75.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e91.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003ePP09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003ePerceived personal control over avoiding TB exposure*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e66.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e83.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable 3. Results of the Delphi Round 2 and Round 3 for Workplace Safety (WS01\u0026ndash;WS29)\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"3\" cellpadding=\"0\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eNo.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eSymbol\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eItem\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eRound 2 Mean\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eSD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e% Consensus\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eRound 3 Mean\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eSD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e% Consensus\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eWS01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eAvailability of N95 respirators\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e91.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e100.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eWS02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eFit-testing program implemented\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e83.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e91.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eWS03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eConsistent mask use in TB areas\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e91.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e100.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eWS04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eHand hygiene adherence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e83.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e91.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eWS05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eAdequate ventilation (natural/mechanical)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e75.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e91.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eWS06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eFunctional airborne isolation rooms\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e75.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e83.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eWS07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eTriage of cough/suspect TB at entry\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e91.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e100.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eWS08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003ePrompt separation of TB suspects\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e66.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e83.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eWS09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eSignage for respiratory hygiene\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e66.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e83.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eWS10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eAvailability of surgical masks for patients\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e75.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e91.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eWS11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eAccess to TB screening for staff\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e83.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e91.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eWS12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003ePeriodic training on TB IPC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e83.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e100.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eWS13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eAdministrative TB IPC policy exists\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e75.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e91.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eWS14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eMonitoring \u0026amp; audit of IPC practices\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e66.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e83.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eWS15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eAdequate PPE stock management\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e75.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e91.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eWS16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eWaste management and disposal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e75.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e91.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eWS17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eUVGI or air-cleaning devices maintained\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e66.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e83.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eWS18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003ePatient flow reduces crowding\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e66.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e83.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eWS19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eRespiratory etiquette promoted\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e75.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e83.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eWS20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eHCW vaccination \u0026amp; health checks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e83.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e91.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eWS21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eRapid diagnostic access for TB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e91.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e100.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eWS22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eSafe sputum collection areas\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e75.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e91.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eWS23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eStaff compliance with isolation protocols\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e83.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e100.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eWS24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eManagement support for TB IPC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e75.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e91.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eWS25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eIncident reporting \u0026amp; feedback loop\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e66.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e83.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eWS26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eAvailability of respirator reuse policy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e66.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e83.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eWS27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eClear TB IPC roles \u0026amp; responsibilities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e75.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e91.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eWS28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eRoutine risk assessment of TB exposure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e83.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e91.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eWS29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eAvailability of TB IPC job aids/posters\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e66.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e83.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable 4. Results of the Delphi Round 2 and Round 3 for TB-Related Stigma (E1\u0026ndash;E7)\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"3\" cellpadding=\"0\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eNo.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eSymbol\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eItem\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eRound 2 Mean\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eSD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e% Consensus\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eRound 3 Mean\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eSD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e% Consensus\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eE1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003ePeople with TB are often treated with less respect\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e83.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e91.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eE2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003ePeople with TB tend to hide their diagnosis to avoid discrimination\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e91.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e100.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eE3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eHaving TB can lead to people avoiding the patient\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e83.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e91.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eE4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003ePeople with TB may lose their job or source of income\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e75.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e83.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eE5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003ePeople with TB often feel ashamed because of the disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e83.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e91.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eE6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eFriends and family may distance themselves from a person with TB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e75.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e83.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eE7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eTB stigma discourages people from seeking timely treatment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e91.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e100.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable 5. Results of the Delphi Round 2 and Round 3 for Latent TB Knowledge (F1\u0026ndash;F6)\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"3\" cellpadding=\"0\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eNo.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eSymbol\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eItem\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eRound 2 Mean\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eSD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e% Consensus\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eRound 3 Mean\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eSD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e% Consensus\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eF1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eLatent TB infection means a person has TB bacteria but no symptoms\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e91.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e100.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eF2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003ePeople with latent TB can spread TB bacteria to others\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e83.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e91.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eF3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003ePeople with latent TB usually feel healthy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e83.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e91.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eF4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003ePeople with latent TB should take preventive treatment to avoid active TB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e91.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e100.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eF5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eWithout treatment, latent TB can progress to active TB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e91.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e100.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eF6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eBCG vaccination prevents latent TB infection\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e75.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e83.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable 6. Results of the Delphi Round 2 and Round 3 for Pulmonary TB Knowledge (G1\u0026ndash;G11)\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"3\" cellpadding=\"0\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eNo.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eSymbol\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eItem\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eRound 2 Mean\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eSD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e% Consensus\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eRound 3 Mean\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eSD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e% Consensus\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eG1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003ePulmonary TB is caused by \u003cem\u003eMycobacterium tuberculosis\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e100.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e100.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eG2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003ePulmonary TB can be transmitted through coughing, sneezing, or speaking\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e100.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e100.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eG3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eTB transmission occurs via sharing food or utensils\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e75.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e83.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eG4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003ePeople with pulmonary TB always have a cough lasting more than two weeks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e83.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e91.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eG5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003ePulmonary TB symptoms can include weight loss, night sweats, and fever\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e91.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e100.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eG6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003ePulmonary TB can only be diagnosed with a chest X-ray\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e75.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e83.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eG7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eSputum examination is an important test for pulmonary TB diagnosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e100.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e100.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eG8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003ePulmonary TB can be completely cured with appropriate treatment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e100.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e100.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eG9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eTB patients must complete their full course of treatment even if symptoms disappear\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e100.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e100.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eG10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eMulti-drug resistant TB occurs when TB bacteria become resistant to at least isoniazid and rifampicin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e91.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e100.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eG11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eBCG vaccination provides lifelong protection against pulmonary TB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e75.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e83.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eIn Table 2, Across five specific domains (perceived TB risk in the workplace (PP01\u0026ndash;PP09), Table 3 workplace safety (WS01\u0026ndash;WS29), Table 4 TB-related stigma (E1\u0026ndash;E7), table 5 knowledge about latent TB [F1\u0026ndash;F6] and table 6 knowledge about pulmonary TB [G1\u0026ndash;11]), the Delphi process indicated a high degree of expert agreement concerning most items in Round 3, which reached or exceeded the 75% consensus. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe highest-level consensus of the PP field was about direct patient contact and infectious aerosol exposure; questions on indirect exposure faced a lower-level agreement before modification. The WS domain had general agreement in terms of the importance given to infection control measures, supply of PPE, and safety rules at the institution; on the other hand, there was initially much variability among its items that are related to administrative enforcement. It is widely believed among the experts that organisational culture, colleagues\u0026apos; attitudes and institutional support are crucial to reducing TB-related stigma (domain E).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThere is an increasing common ground that leadership needs to be part of this work. F (latent TB) and G (pulmonary TB Knowledge) is almost always very similar for the knowledge items, such as knowing how TB is diagnosed and treated. Some thought that receiving the BCG vaccine would give them lifelong immunity or that an X-ray of their chest would be enough for diagnosis. People didn\u0026rsquo;t agree with these ideas at first, but they grew better when the items were on paper because they were more transparent. The items became much clearer and closer to what experts agreed on after the Delphi rounds. This resulted in a complete questionnaire that addressed the potentially important categories.\u003c/p\u003e\n\u003cp\u003eFigure 1 illustrates the incremental process that was used to form a consensus in this Delphi study, and shows how questionnaire items were systematically revised through expert involvement. It illustrates how the research evolved from initial item generation to repeated expert rating, as with each iteration clarity/certainty increased until stability. The incremental process of development highlights transparency in which the expert feedback guided the portion towards the stepwise, and it provides information on how all steps led to the final POR-TB, adding scientific robustness and contextual applicability for TB risk among HCWs from an occupational standpoint.\u003c/p\u003e\n\u003cp\u003eThe Round 3 questionnaire included all elements of content from the five domains \u0026ndash; perceived occupational TB risk (PP01\u0026ndash;PP09), health and safety climate (WS01\u0026ndash;WS29), stigma (E1\u0026ndash;E7), knowledge of LTBI (F1\u0026ndash;F6) and knowledge about PTB (G1\u0026ndash; G11) \u0026ndash; that had been refined following feedback elicited in Round 2. All 12 Round-2 experts were invited to participate in Round 3, and all accepted the invitation, resulting in a 100% response rate. In Round 3, the lack of consent could have come from \u0026lt;75% in at least four out of five domains. Nevertheless, 90% agreement is what most of the items wind up getting. This indicates that the majority of experts from the panel agree on how clear, relevant and important each questionnaire item is. This demonstrates that the final instrument is reliable and has content validity.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eDelphi study results There was a high consensus among experts on the core domains and items to assess HCWs’ perception of TB risk at the workplace, safety in the work environment, stigma, and TB referral knowledge. In the perception of occupational risk for TB (PP01–PP09) field, all items exceeded the consensus threshold, reflecting consensus about the importance of evaluating healthcare worker recognition about their personal risks for exposure to TB in clinical settings. This is consistent with previous evidence that the risk perception plays an important role in preventive behavior of healthcare worker and adherence to infection prevention and control (IPC) measures [17-20]. The addition of items concerning patient contact and environmental exposure gives a fuller picture of identified risks for tuberculosis in the hospital.\u003c/p\u003e\n\u003cp\u003eIn the workplace safety sector (WS01–WS29), assessing the safety culture was emphasized to be crucial and must include management support, IPC training, PPE, and enough ventilation. Results suggest that the organisational commitment to safety in the workplace would have a direct effect on tuberculosis transmission risk at HCWs [21-25]. There is also agreement on the need for ongoing safety training and periodic risk assessment, which aligns with guidance on health worker protection in high-burden settings outlined in WHO’s 2023 Global TB Report [1]. The broad item sampling curve ensures that the scale cuts both physical resources and safety-related behaviors.\u003c/p\u003e\n\u003cp\u003eThere was agreement on all the items within the TB-related stigma area (E1–E7), which indicates that there is still an understanding of stigma towards persons with TB in HCWs. Stigmatisation leads to low patient trust, low care-seeking and low treatment compliance [26-29] This area involves attitudes and behaviors associated with the stigma domain, corresponding to current theoretical frameworks that separate enacted, perceived and internalized stigma [30-33]. The consensus of experts highlights the need for TB programs for HCWs to integrate stigma-reduction interventions [34-35]\u003c/p\u003e\n\u003cp\u003eThe latent TB domain (F1–F6) observed high concurrence in the items measuring perceptions of TB infection versus active disease, risk of transmission, and procedures associated with preventive therapy. This is in line with studies showing that among HCWs, often knowledge gaps on LTBI are present, leading to underdiagnosis and missed prevention opportunities [36-37]. Inclusion of knowledge-based questions is even more important in Indonesia, where the burden and exposure risk among health care workers is high [24]. Adequate competency in LTBI management harmonizes with the End TB Strategy targets on coverage of preventive treatment.\u003c/p\u003e\n\u003cp\u003eAll questions in the pulmonary TB (G1–G11) knowledge domain showed high consensus, indicating that the panel could agree on the importance of biomedical knowledge for tuberculosis control. Sources relating to signs and symptoms of TB, transmission, diagnostic modality, and treatment protocols are consistent with the World Health Organisation (WHO) global tuberculosis competencies for healthcare workers [36]. Previous evidence shows that limited tuberculosis knowledge among health care workers is related with delay in diagnosis, and suboptimal treatment initiation [37-38] therefore clearly indicating the importance of this dimension in the questionnaire.\u003c/p\u003e\n\u003cp\u003eThe incorporation of the perceived risk (PP) and workplace safety (WS) dimensions addresses the interactions between individual cognition and structural workplace factors. Studies in occupational health suggest that risk perception on its own may not be enough to encourage protective behaviour, unless the environment and organisational support mechanisms are in place [39]. The high degree of agreement in either category is suggestive of how the expert panel considers these two categories to be interconnected, and supports an overarching approach to assessment, recognising both psychosocial and systems-related factors affecting TB preventive behaviour.\u003c/p\u003e\n\u003cp\u003eThere is broad professional agreement that TB health care workers’ attitudes have an influence on infection control measures and patient involvement. Fear-driven fears have been related to increased quarantine measures and avoidance of patient contact, although this might ironically affect the quality of care [40] Focused education and infrastructure modifications could increase compliance with IPC, resulting in improved patient-centred care.\u003c/p\u003e\n\u003cp\u003eThe domains of knowledge (F and G) contribute to the perception and safety domains by providing an objective assessment of TB-specific skills. Changing TB epidemiology, such as that posed by multidrug-resistant TB and the inclusion of preventive therapy, demands that healthcare workers remain educated [41] These consistencies between the fields are consistent with the panel's assertion that knowledge assessment should be incorporated into occupational TB risk screening instruments.\u003c/p\u003e\n\u003cp\u003eThis study used the Delphi technique to verify that the questions included in a final tool were evidence-based and contextually relevant to tuberculosis burden and healthcare system for Indonesia. Previous TB risk assessment instruments developed in other settings have faced challenges when adapted to another cultural context [13-15]. Nevertheless, the iterative consensus method used in this study enabled us to tailor items to local epidemiological and occupational contexts. This increases likelihood of their adoption and application in practical tuberculosis control programs.\u003c/p\u003e\n\u003cp\u003eThere is strong consensus across all domains meaning that the final instrument has good content validity and anticipated acceptability among HCWs and TB programme implementers. The instrument provides a holistic model of assessing health care worker readiness for occupational TB transmission by targeting perceived risk, safety issues in the workplace, stigma, and knowledge of both latent and active TB. Further research should be directed towards psychometric validation, in particular construct validity and reliability assessment and predictive validity with real IPC behaviour in healthcare.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eTwelve experts achieved consensus using a three-round Delphi method to construct a 63-item questionnaire for measuring Perceived Occupational Risk of Tuberculosis (POR-TB). The questionnaire asked about five topics: whether you think that you will get tuberculosis, how safe you think your workplace is, how much you know about latent tuberculosis, and also pulmonary (lung) tuberculosis knowledge. The tool is locally relevant to evaluate infection prevention and control practices of HCWs within the Indonesian workplace and can be used for context-targeted direction regarding ethical, scientific policy approaches and research planning. The Delphi approach allows in-depth input from experts and provides consensus but does not quantify specific items on the basis of importance or predictive efficiency. Next studies should be directed to the psychometric validation, either with HCWs in different provinces, and a higher sample size or different types of validity values using EFA/CFA and SEM techniques to establish the construct validity, reliability levels, and structural domain of the POR-TB questionnaire.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eEthics approval This study was reviewed and approved by the Health Research Ethics Committee (Komite Etik Penelitian Kesehatan) of the Faculty of Medicine, Universitas Tanjungpura, Indonesia. Participant consent All participants were adult healthcare workers who provided informed consent prior to participation. Consent was obtained electronically via the online Delphi survey; participation was voluntary and responses were anonymized. No patient data were collected, and consent to publish aggregated, de-identified results was obtained.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eAcknowledgment\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThese study was funded by a grant from the Royal Society of Tropical Medicine and Hygiene (RSTMH) and from the National Institutes of Health (NIH). All experts who participated in the Delphi rounds and provided feedback for the development of the POR-TB are gratefully acknowledged by the authors.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eWorld Health Organization. (2023). \u003cem\u003eGlobal Tuberculosis Report 2023\u003c/em\u003e. Geneva: WHO\u003c/li\u003e\n\u003c/ol\u003e\n\u003col start=\"2\"\u003e\n\u003cli\u003e\u003cstrong\u003e. \u003c/strong\u003eMadzinga D, Tshitangano TG, Raliphaswa NS, Razwiedani L. Healthcare Workers' Perception of Measures to Reduce the Risk of New Tuberculosis Infections: A Qualitative Study Report. 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PMID: 36962407; PMCID: PMC10021216.\u003c/li\u003e\n\u003cli\u003eSartika I, Insani WN, Abdulah R. Assessment of Health-Related Quality of Life among Tuberculosis Patients in a Public Primary Care Facility in Indonesia. J Glob Infect Dis. 2019 Jul-Sep;11(3):102-106. doi: 10.4103/jgid.jgid_136_18. PMID: 31543651; PMCID: PMC6733192.\u003c/li\u003e\n\u003cli\u003eBodur MS, \u0026Ccedil;il B. A Research on Healthcare Professionals\u0026rsquo; Stigma Towards Tuberculosis Patients. Thorac Res Pract. 2025 Apr 30;26(3):88-96. doi: 10.4274/ThoracResPract.2024.24079. Epub 2025 Jan 27. PMID: 39930730; PMCID: PMC12047200.\u003c/li\u003e\n\u003cli\u003eChen, X., Du, L., Wu, R.\u003cem\u003eet al.\u003c/em\u003e Tuberculosis-related stigma and its determinants in Dalian, Northeast China: a cross-sectional study. \u003cem\u003eBMC Public Health\u003c/em\u003e \u003cstrong\u003e21\u003c/strong\u003e, 6 (2021). https://doi.org/10.1186/s12889-020-10055-2\u003c/li\u003e\n\u003cli\u003eSridevi NH, \u0026amp; Nandini C. (2019). Knowledge, Attitude and Practices on Tuberculosis Infection Control among Health Workers in Shivamogga.\u003cem\u003eNational Journal of Community Medicine\u003c/em\u003e, \u003cem\u003e10\u003c/em\u003e(11), 575\u0026ndash;578. Retrieved from https://njcmindia.com/index.php/file/article/view/571.\u003c/li\u003e\n\u003cli\u003eCherkaoui I, Sabouni R, Ghali I, Kizub D, Billioux AC, Bennani K, et al. (2014) Treatment Default amongst Patients with Tuberculosis in Urban Morocco: Predicting and Explaining Default and Post-Default Sputum Smear and Drug Susceptibility Results. PLoS ONE 9(4): e93574. https://doi.org/10.1371/journal.pone.0093574\u003c/li\u003e\n\u003cli\u003eWHO. (2021). \u003cem\u003eWHO policy on TB infection prevention and control in healthcare settings\u003c/em\u003e.Geneva: World Health Organization.\u003c/li\u003e\n\u003cli\u003eZhang J, Zhou X, Wang H, Luo Y, Li W. Development and Validation of the Humanistic Practice Ability of Nursing Scale. Asian Nurs Res (Korean Soc Nurs Sci). 2021 May;15(2):105-112. doi: 10.1016/j.anr.2020.12.003. Epub 2021 Jan 14. PMID: 33453453..\u003c/li\u003e\n\u003cli\u003eChitu Okoli, Suzanne D. Pawlowski, The Delphi method as a research tool: an example, design considerations and applications, Information \u0026amp; Management, Volume 42, Issue 1, 2004, Pages 15-29, ISSN 0378-7206, https://doi.org/10.1016/j.im.2003.11.002\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"discover-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Discover Public Health](https://link.springer.com/journal/12982)","snPcode":"12982","submissionUrl":"https://submission.springernature.com/new-submission/12982/3","title":"Discover Public Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Tuberculosis, healthcare workers, occupational health, risk perception, Delphi method","lastPublishedDoi":"10.21203/rs.3.rs-7763696/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7763696/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e\u003cbr\u003e\nHealthcare workers (HCWs) in high tuberculosis (TB) burden countries, including Indonesia, face substantially elevated occupational risk of Mycobacterium tuberculosis infection and disease. Understanding HCWs’ perceived occupational risk is essential for designing effective infection prevention and control (IPC) measures. There is currently no validated, context-specific tool in Indonesia that can be used to measure this construct. The CHART-TB project seeks to fill this gap through the development of a Perceived Occupational Risk of Tuberculosis (POR-TB) questionnaire. The aim is to get experts to agree on the content and structure of the POR-TB questionnaire through a multi-round Delphi process.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e\u003cbr\u003e\nA modified Delphi method was conducted in three rounds between April and June 2024. The questionnaire comprised five domains: perceived TB risk (9 items), workplace safety (29 items), TB-related stigma (7 items), latent TB knowledge (6 items), and pulmonary TB knowledge (11 items). In Round 1, an online discussion with 12 experts in TB control, occupational health, behavioural science, and public health generated and refined the initial item pool. In Rounds 2 and 3, experts rated the relevance and importance of each item on a 5-point Likert scale (1 = not important to 5 = very important). Consensus was defined as ≥75% agreement (ratings of 4 or 5) with an interquartile range (IQR) ≤1.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e\u003cbr\u003e\nRound 1 produced 63 items across the five domains. In Round 2, 57 items (90.5%) achieved the consensus threshold, whereas 6 items were revised for clarity in response to qualitative feedback. In Round 3, all 63 items were agreed upon, with median scores between 4.7 and 5.0 and agreement rates between 88% and 100%, showing that the agreement was very stable. The original structure of the domain was kept, and no items were taken away.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e\u003cbr\u003e\nThe three-round Delphi process produced a POR-TB questionnaire containing 63 items with strong expert consensus in five domains that form the core of TB risk perception in the workplace among healthcare workers. The instrument will undergo psychometric validation in a larger, multi-provincial study to establish its reliability and validity for guiding targeted TB IPC interventions in Indonesian healthcare settings.\u003c/p\u003e","manuscriptTitle":"Establishing Consensus of Perceived Occupational Risk of Tuberculosis (POR-TB) Among Healthcare Workers: A Delphi Study in Indonesia","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-07 17:35:15","doi":"10.21203/rs.3.rs-7763696/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-12-01T07:13:46+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-29T19:41:54+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-27T15:26:53+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"124768594638703720569801052470528906452","date":"2025-11-22T11:46:42+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"116570604490183835680772904354554705182","date":"2025-11-19T08:49:29+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-18T07:58:10+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"78894103518036805734295283748033418184","date":"2025-11-18T07:18:11+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-11-17T06:16:02+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-11-03T16:23:31+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-10-10T06:56:54+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-10-10T06:51:34+00:00","index":"","fulltext":""},{"type":"submitted","content":"Discover Public Health","date":"2025-10-02T04:38:36+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"discover-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Discover Public Health](https://link.springer.com/journal/12982)","snPcode":"12982","submissionUrl":"https://submission.springernature.com/new-submission/12982/3","title":"Discover Public Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"56b5e78a-a007-47f9-9d43-2c2ae4f1f12c","owner":[],"postedDate":"October 7th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-12-22T16:02:20+00:00","versionOfRecord":{"articleIdentity":"rs-7763696","link":"https://doi.org/10.1186/s12982-025-01240-y","journal":{"identity":"discover-public-health","isVorOnly":false,"title":"Discover Public Health"},"publishedOn":"2025-12-15 15:57:59","publishedOnDateReadable":"December 15th, 2025"},"versionCreatedAt":"2025-10-07 17:35:15","video":"","vorDoi":"10.1186/s12982-025-01240-y","vorDoiUrl":"https://doi.org/10.1186/s12982-025-01240-y","workflowStages":[]},"version":"v1","identity":"rs-7763696","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7763696","identity":"rs-7763696","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}