Striving for Improved Infection Prevention and Control Practice: A Grounded Theory of Healthcare Workers' Struggles in Implementing Infection Prevention and Control Guidance in Uganda

There is a scarcity of qualitative research focusing on the implementation of infection prevention and control (IPC) guidance in low-income countries. This study aimed to address this gap by exploring the perspectives of healthcare workers (HCWs) regarding the implementation of IPC guidance at the healthcare facility level in Uganda. The study also sought to generate a theoretical understanding of the processes involved in implementing IPC guidance in these settings. This robust qualitative research employed a design based on constructivist grounded theory methodology, conducting individual interviews with 13 frontline health workers such as doctors, nurses, nurse interns, and laboratory staff. The key findings of the study revealed that HCWs undergo a process of 'striving for improved practice' in their efforts to implement IPC guidance. This process involved four phases: recognising the importance of IPC, playing a role, encountering challenges, and overcoming challenges. However, achieving full implementation proved difficult due to various individual and organisational barriers presented by the low-income setting. HCWs employed improvisation as a means to overcome these obstacles. Additionally, the study identified enabling factors that facilitated the implementation of IPC guidance within these settings. This study is significant as it applies robust qualitative research methods to provide valuable evidence of HCWs' perspectives on an important topic in an under-researched context, with findings transferable to similar settings.