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

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.