User experience and patient satisfaction with tuberculosis care in low- and middle-income countries: A systematic review

Cazabon, Danielle; Pande, Tripti; Sen, Paulami; Daftary, Amrita; Arsenault, Catherine; Bhatnagar, Himani; O’Brien, Kate; Pai, Madhukar

doi:10.1016/j.jctube.2020.100154

“…There is literature that shows that patients’ experience of being given no explanation about their disease and not keeping information confidential is associated with loss to follow-up. 36 Another study also found the explanation of illness and appropriate treatment by clinicians to be very important to patients. 37 The literature shows that a clear explanation of the diagnosis and good staff attitudes were among the important attributes determining health-seeking behaviour.…”

Section: Discussionmentioning

confidence: 99%

‘The nurse did not even greet me’: how informed versus non-informed patients evaluate health systems responsiveness in South Africa

Hompashe

¹

,

Gerdtham

²

,

Christian

³

et al. 2021

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Introduction Universal Health Coverage is not only about access to health services but also about access to high-quality care, since poor experiences may deter patients from accessing care. Evidence shows that quality of care drives health outcomes, yet little is known about non-clinical dimensions of care, and patients’ experience thereof relative to satisfaction with visits. This paper investigates the role of non-clinical dimensions of care in patient satisfaction. Methods Our study describes the interactions of informed and non-informed patients with primary healthcare workers at 39 public healthcare facilities in two metropolitan centres in two South African provinces. Our analysis included 1357 interactions using standardised patients (for informed patients) and patients’ exit interviews (for non-informed patients). The data were combined for three types of visits: contraception, hypertension and tuberculosis. We describe how satisfaction with care was related to patients’ experiences of non-clinical dimensions. Results We show that when real patients (RPs) reported being satisfied (vs dissatisfied) with a visit, it was associated with a 30% increase in the probability that a patient is greeted at the facilities. Likewise, when the RPs reported being satisfied (vs dissatisfied) with the visit, it was correlated with a 15% increase in the prospect that patients are pleased with healthcare workers’ explanations of health conditions. Conclusion Informed patients are better equipped to assess health-systems responsiveness in healthcare provision. Insights into responsiveness could guide broader efforts aimed at targeted education and empowerment of primary healthcare users to strengthen health systems and shape expectations for appropriate care and conduct.

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“…Approximately 51% of the adult TB patients in our study initiated care in the formal and informal private sector where studies in LMICs have shown that such providers often lack knowledge of TB symptoms, and TB diagnostic facilities are frequently unavailable ( Cazabon et al, 2020 , Daniels et al, 2019 , Das et al, 2015 ). This finding is comparable to the report of a combined patients pathway analysis (PPA) from 13 high TB burden countries in Africa and south-East Asia, where about 60% of all TB patients initiated care in the private sector ( Chin and Hanson, 2017 ).…”

Section: Discussionmentioning

confidence: 99%

Delay in the diagnosis of pulmonary tuberculosis in The Gambia, West Africa: A cross-sectional study

Owolabi

¹

,

Jallow

²

,

Jallow

³

et al. 2020

International Journal of Infectious Diseases

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Highlights Provision of high quality of TB care is crucial for the End TB Strategy. COVID-19 pandemic will have grave consequences for TB patients. Delay in diagnosis of TB is a surrogate of quality of TB care. There is considerable delay in the diagnosis of TB in The Gambia. Need for better understanding of patient pathways to care.

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“…Successful adherence for diseases with a prolonged treatment course, such as MDR-TB, requires a high level of dosing implementation (ie, taking a medication dose on a given day) and persistence (ie, taking medications for the entire duration of therapy [ 3 ]). Factors contributing to nonadherence are complex and include therapy-related (eg, toxicities [ 4 ]), psychosocial (eg, alcohol use [ 5 ], depression [ 6 ], and stigma [ 7 ]), structural (eg, distance from clinics and medication costs [ 8 , 9 ]), and health system–related challenges (eg, poor user experience with the health system). Patients with MDR-TB face particularly high levels of drug toxicity [ 4 ] and psychosocial barriers, including depression, substance use disorders, stigma, and discrimination [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

Acceptability of the Medication Event Reminder Monitor for Promoting Adherence to Multidrug-Resistant Tuberculosis Therapy in Two Indian Cities: Qualitative Study of Patients and Health Care Providers

Thomas¹,

Kumar²,

Nagarajan³

et al. 2021

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Background Patients with multidrug-resistant tuberculosis (MDR-TB) face challenges adhering to medications, given that treatment is prolonged and has a high rate of adverse effects. The Medication Event Reminder Monitor (MERM) is a digital pillbox that provides pill-taking reminders and facilitates the remote monitoring of medication adherence. Objective This study aims to assess the MERM’s acceptability to patients and health care providers (HCPs) during pilot implementation in India’s public sector MDR-TB program. Methods From October 2017 to September 2018, we conducted qualitative interviews with patients who were undergoing MDR-TB therapy and were being monitored with the MERM and HCPs in the government program in Chennai and Mumbai. Interview transcripts were independently coded by 2 researchers and analyzed to identify the emergent themes. We organized findings by using the Unified Theory of Acceptance and Use of Technology (UTAUT), which outlines 4 constructs that predict technology acceptance—performance expectancy, effort expectancy, social influence, and facilitating conditions. Results We interviewed 65 patients with MDR-TB and 10 HCPs. In patient interviews, greater acceptance of the MERM was related to perceptions that the audible and visual reminders improved medication adherence and that remote monitoring reduced the frequency of clinic visits (performance expectancy), that the device’s organization and labeling of medications made it easier to take them correctly (effort expectancy), that the device facilitated positive family involvement in the patient’s care (social influences), and that remote monitoring made patients feel more cared for by the health system (facilitating conditions). Lower patient acceptance was related to problems with the durability of the MERM’s cardboard construction and difficulties with portability and storage because of its large size (effort expectancy), concerns regarding stigma and the disclosure of patients’ MDR-TB diagnoses (social influences), and the incorrect understanding of the MERM because of suboptimal counseling (facilitating conditions). In their interviews, HCPs reported that MERM implementation resulted in fewer in-person interactions with patients and thus allowed HCPs to dedicate more time to other tasks, which improved job satisfaction. Conclusions Several features of the MERM support its acceptability among patients with MDR-TB and HCPs, and some barriers to patient use could be addressed by improving the design of the device. However, some barriers, such as disease-related stigma, are more difficult to modify and may limit use of the MERM among some patients with MDR-TB. Further research is needed to assess the accuracy of MERM for measuring adherence, its effectiveness for improving treatment outcomes, and patients’ sustained use of the device in larger scale implementation.

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User experience and patient satisfaction with tuberculosis care in low- and middle-income countries: A systematic review

Cited by 19 publications

References 50 publications

‘The nurse did not even greet me’: how informed versus non-informed patients evaluate health systems responsiveness in South Africa

‘The nurse did not even greet me’: how informed versus non-informed patients evaluate health systems responsiveness in South Africa

Delay in the diagnosis of pulmonary tuberculosis in The Gambia, West Africa: A cross-sectional study

Acceptability of the Medication Event Reminder Monitor for Promoting Adherence to Multidrug-Resistant Tuberculosis Therapy in Two Indian Cities: Qualitative Study of Patients and Health Care Providers

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