Assessing Staff Readiness for Integrated Tuberculosis Diabetes Care in different Districts of Pakistan: A Cross-Sectional Study Using the R = Mc² Implementation Framework

ABSTRACT OBJECTIVES This study aimed to assess TB staff readiness to integrate diabetes care within TB services in selected basic medical units in Pakistan using the R = MC² implementation framework. METHODOLOGY We conducted a cross-sectional study to assess staff readiness across 13 TB Basic Management Units in 5 districts of Pakistan from November 2024 to April 2025. We conceptualized readiness in three different domains, that is, Motivation, General Capacity, and Capacity for Change, rather than in one composite index, and we measured it at the construct level. DOTS facilitators directly involved in TB service delivery completed a structured questionnaire measuring motivation (12 items), General Capacity (5 items), and Capacity for Change (4 items). We performed reliability analysis using Cronbach’s alpha. Although composite scores were calculated to provide descriptive information, interpretation focused on domain-specific results to maintain theoretical consistency and construct validity. RESULTSThirteen DOTS facilitators from primary (n=4), secondary (n=5), and tertiary (n=4) TB facilities participated. Reliability was acceptable for motivation (α = 0.802) and excellent for General Capacity (α = 0.918), while Capacity for Change showed moderate reliability (α = 0.548). Motivation was high (mean = 4.2), whereas General Capacity was lowest (mean = 2.9), reflecting resource, training, and coordination gaps. Capacity for change was moderate (mean = 3.3). A strong correlation was observed between General Capacity and Capacity for Change (r = 0.69, 95% CI 0.20–0.90, p < 0.009). CONCLUSION The study findings highlighted that staff in TB BMUs were greatly motivated to incorporate TB–DM care, yet the capacity limitations constrain the readiness. Scaling up integrated care should be preceded by strengthening operational resources, coordination, and implementation support.