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Table 2 Categories, sub-categories and themes

From: Factors influencing COVID-19 testing: a qualitative study in Bhutan

 

Categories

Sub-categories

Themes

Facilitators

1. Governance and leadership

1.1 Political leadership

Compassionate leadership and guidance

Personal assistance in provision of relief measures

Improved community participation led by the King

Political will and support to get the mass tested

Health as a high-priority sector in national governance

  

1.2 Community leadership

Designated volunteer and champions in the community

High community willingness to be tested

Community engagement to provide key information and services

Adherence to COVID-19 guidelines

Engagement of religious heads and leaders in advocacy programs

  

1.3 Health governance system

Adherence to WHO recommendations

National COVID-19 response plan/protocol

Effective early preparedness and planning

Evidence-based testing protocols and strategies

Effective response to procurement challenges through health governance

Lessons learned from the previous pandemic, MERS

 

2. Resources

2.1 Capacities of in-service personnel

Positive attitude of health professionals

Training for community members, medical students to fill the human resource gap

Improved interpersonal relationships across agencies

Improved confidence of health professionals to work in high-risk areas with Personal Protective Equipment (PPEs)

  

2.2 Financial and material Resources

Government's financial support to get tested of COVID-19

Effective resource mobilization

Door-to-door sampling strategy eased testing procedures

Sufficiency in supplies—PPEs, test kits, cold chain,

Rapid expansion of testing sites and facilities

 

3. Health service delivery

3.1 Primary Health Care (PHC)

Stronger PHC health system targeting Universal Health Coverage (UHC)

Establishment of flu clinics to screen suspected COVID cases away from the hospitals

24 hours health helpline for all, including ambulatory services

  

3.2 Surveillance

System in place to trace and treat vulnerable population

Online reporting and monitoring system

Ability to identify defaulters and get them tested

Effective monitoring system to ensure the adequacy of materials for testing

Zoning system to facilitate easy access for testing at the place of dwelling

 

4. Whole of Society Approaches (WOS)

 

Active engagement of intergovernmental organizations and private sectors, armed forces, civil society organizations and volunteer groups

 

5. Use of digital technology

 

Good data management system that updates daily COVID-19 situation

Systematic and comprehensive collection of samples using the national demographic data

Geographic information system (GIS) mapping to identify a high-risk population

Barriers

1. Geographical barriers

1.1 Porous border with neighboring countries

Potential risks and outbreaks from neighboring countries

  

1.2 Poor transport networks

Delays in the transportation of supplies to remote districts

Poor transport networks due to season changes

 

2. Lack of human resources

 

Lack of epidemiologists and biomedical engineers

Shortage of health professionals and mid-level managers for conducting COVID-19 testing

Challenges of using online technology when training health professionals in all regions of Bhutan

 

3. Misconceptions about COVID-19 testing

3.1 Misconceptions about symptoms of COVID-19

Misconceptions about symptoms of COVID-19 as symptoms of seasonal flu

  

3.2 Fear of nasal swab for COVID-19 testing

Misconceptions about negative health implications associated with nasal swab due to misinformation through mass media