Psychological and Educational Intervention to Improve Tuberculosis Treatment Adherence in Ethiopia Based on Health Belief Model: A Cluster Randomized Control Trial

Abstract

BackgroundTreatment non-adherence results in treatment failure, prolonged transmission of disease and emergence of drug resistance. Although the problem widely investigated, there remains an information gap on the effectiveness of different methods to improve treatment adherence and the predictors of non-adherence in resource limited countries based on theoretical models. This study aimed to evaluate the impact of psychological counseling and educational intervention on tuberculosis (TB) treatment adherence based on Health Belief Model (HBM).MethodologyA cluster randomized control trial was conducted in Addis Ababa from May to December, 2014. Patients were enrolled into study consecutively from 30 randomly selected Health Centers (HCs) (14 HCs intervention and 16 HCs control groups). A total of 698 TB patients, who were on treatment for one month to two months were enrolled. A structured questionnaire was administered to both groups of patients at baseline and endpoint of study. Control participants received routine directly-observed anti-TB therapy and the intervention group additionally received combined psychological counseling and adherence education. Treatment non-adherence level was the main outcome of the study, and multilevel logistic regression was employed to assess the impact of intervention on treatment adherence.ResultsAt enrollment, the level of non-adherence among intervention (19.4%) and control (19.6%) groups was almost the same. However, after intervention, non-adherence level decreased among intervention group from 19.4 (at baseline) to 9.5% (at endpoint), while it increased among control group from 19.4% (baseline) to 25.4% (endpoint). Psychological counseling and educational interventions resulted in significant difference with regard to non-adherence level between intervention and control groups (Adjusted OR = 0.31, 95% Confidence Interval (CI) (0.18–0.53), p < 0.001)).ConclusionPsychological counseling and educational interventions, which were guided by HBM, significantly decreased treatment non-adherence level among intervention group. Provision of psychological counseling and health education to TB patients who are on regular treatment is recommended. This could be best achieved if these interventions are guided by behavioral theories and incorporated into the routine TB treatment strategy.Trial RegistrationPan African Clinical Trials Registry PACTR201506001175423

Health Belief Model and PRECEDE PROCEED on the Risk Factors of Multidrug Resistant Tuberculosis in Surakarta, Central Java

“…Direct association between perceived susceptibility and drug taking adherence was positive and significant. The study result was in accordance with the previous finding that mentioned individual belief role in HBM influenced individual decision in increasing health behaviors, one of them was adherence in taking TB medications (Johari et al, 2014;Tola et al, 2016). 5.…”

“…In addition according to Patiung et al (2014) one of the factors related to the TB patients is nutritional status. One of the models recommended to explain and understand health behavior including TB patients' drug taking adherence is Health Belief Model (HBM) (Tola et al, 2016). In addition to HBM, PRECEDE PROCEED model is also good to be used in understanding health behavior.…”

The epidemiology, pathogenesis, transmission, diagnosis, and management of multidrug-resistant, extensively drug-resistant, and incurable tuberculosis

“…Psychosocial support, patient involvement, education, and treatment literacy are important for good outcomes. 518 DOT for tuberculosis is disempowering. Preferential adherence to antiretroviral therapy over MDR and XDR tuberculosis treatment might be because antiretroviral therapy is the patient's responsibility; patients receive education and counselling for antiretroviral therapy and understand it, whereas tuberculosis notification is incriminating and XDR tuberculosis is clinically isolating.…”

The Association Between Perceived Stigma Towards Tuberculosis and the Implementation of Diagnosis Procedure on Tuberculosis Screening Program in Denpasar, Bali, Indonesia

“…This fact showed that stigma towards TB are still exist in the populations even in urban area such as in Denpasar City. In the other areas (rural) of Bali, the perceived stigma towards TB might be higher than this finding.Stigma towards TB should be solvedintegrally in TB control program.An education for presumptive TB cases should include psychological intervention to reduce perceived stigma (Tola et al, 2016). A community intervention is alsoessential for educating people in the population such community leaders, public figures, religious leaders and non-government organizations.…”