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Indian Journal of Community Medicine

Effects Of Drug Administration Strategy And Health Education On Knowledge Of Pulmonary Tuberculosis Patients Admitted To A Tuberculosis Hospital

Author(s): Brig. L. Pichu

Vol. 29, No. 1 (2004-01 - 2004-03)

Headquarters Northern Command, C/o 56 APO

Abstract:

Research question: Does health education improve knowledge about the disease among patients undertaking treatment for the same?

Objective: To assess the effect of health education with booklet on knowledge of TB patients, treated under DOTS programme.

Study design: Comparative study between pre and post phases of DOTS programme with and without health education booklet.

Setting: Army Tuberculosis Hospital at Namkum.

Participants: Randomly selected 60 male participants with freshly diagnosed Pulmonary Tuberculosis treated under DOTS programme with and without health education booklet.

Statistical analysis: Simple proportions, t-test.

Results: To study the effect of DOTS strategy and health education on knowledge of TB patients, 30 male patients each treated under DOTS programme with and without use of health education booklet (HE) were investigated. There was significant improvement in post test knowledge in both the groups but health education booklet had no significant role in improving the knowledge of tuberculosis among patients undertaking DOTS strategy.

Keywords: Tuberculosis, DOTS, Health education, Intervention trial

Introduction:

Tuberculosis a highly feared disease, known for centuries to affect, debilitate, impoverish large sections of the populations and even killer continues to ravage the world and especially the developing world. Tuberculosis is today the biggest infectious killer among young people and adults. In 1993, WHO Global Tuberculosis Programme declared TB as a global emergency and promoted Dr. Styblo's strategy in a technical and management package known by the brand name, DOTS. DOTS is a strategy which stands for Directly Observed Treatment Short-course and is the single, most effective health strategy available today for tuberculosis control.1 DOTS is a community based tuberculosis treatment and care strategy which combines the benefits of supervised treatment and the benefits of the community based care and support.2 Lack of awareness or incorrect knowledge about the disease might lead to harbouring of wrong beliefs and misconception about various aspects of the disease which may affect the timely reporting of patient to the health institutions or poor compliance. Equally important is to assess the impact of various strategies adopted for improving knowledge and compliance.

Material and Methods:

The present study was conducted among freshly diagnosed pulmonary tuberculosis patients admitted to a Military Tuberculosis Hospital in Bihar from January to June 2000. The study population consisted of 60 patients. Random sampling was used to select the two groups of 30 patients each of pulmonary tuberculosis taking DOTS therapy, i.e. control group consisting of patients taking DOTS only, while intervention group consisted of Pulmonary tuberculosis patients taking DOTS along with use of health education booklet. Intervention group was to read the health education booklet whenever needed and ask questions to clarify their doubts about the disease at any point of time.

The health education booklet on Pulmonary TB was developed by the researcher based on the knowledge questions administered to the patients. It consisted of the following five aspects of pulmonary tuberculosis :

  1. Causes, spread and prevention.
  2. Health practices and life style (predisposing factors)
  3. Location and clinical features.
  4. Side effects of drugs and complications.
  5. Early detection and screening.

The research design adopted for the present study was pre and post test design among patients of the two groups. The pre-test knowledge questionnaire on Pulmonary TB was administered on 2nd-3rd day of admission of the patient to the hospital while post-test knowledge questionnaire was administered on completion of 30 days of treatment. The reliability of researcher developed knowledge questionnaire was established (r=0.71) by split half technique at 0.05 level.

Results:

Table I: Distribution of patients according to age, education and severity of illness.

Age (yrs) Control Group Intervention Group
No. % No. %
18-25 16 53.3 10 33.3
26-35 10 33.3 10 33.3
36-45 04 13.3 05 16.6
46-55 - - 05 16.6
Education
illiterate - - 02 6.6
Primary 02 6.6 05 16.6
Secondary 28 93.3 23 76.6
Severity of Illness (Sputum)
P+ 12 40.0 16 53.3
P++ 04 13.3 06 20.0
P+++ 07 23.3 08 26.6
P++++ 07 23.3 - -

77% of patients in both the groups were in the reproductive age group of 18-35 years. Only 15% of patients were in the age group 36-45 years. The mean age of patients in the present study was 29.77 yrs. All the patients selected were males being a Military Hospital where indoor treatment facilities existed only for serving personnel. 85% of patients in both the groups had secondary education while only 6.6% were illiterate. Majority (92%) of the cases were Hindus. 46.7% of total patients selected in two groups were found to be suffering from mild illness (sputum positive P+). 23.3% of patients in the control group were found to be suffering from severe illness (sputum P++++) while there was no such patient in the intervention group (Table I).

Table II: Comparison of mean knowledge score about various aspects of Tuberculosis among patients.

Tuburculosis Variable Control Group Interrvention Group
Pretest mean Post Test Mean T-value p-value Pretest mean Post Test Mean T-value p-value
Score SD Score SD Score SD Score SD
Causes, spread and prevention 11.52 2.16 12.90 1.58 2.74 <0.05 12.04 2.33 13.61 1.44 3.07 <0.05
Health Practices and lifestyle 4.66 2.36 6.10 3.59 1,79 >0.05 5.32 3.06 6.11 3.42 0.92 >0.05
Location and clinical features 7.27 1.38 8.00 0.00 2.83 <0.05 7.68 0.81 7.96 0.18 1.80 >0.05
Side effects of drug and complications of TB 15.83 2.80 19.20 3.82 4.38 <0.05 17.36 1.94 19.50 2.70 3.45 <0.05
Early detecting and screening 4,43 1.04 4.66 0.88 0.90 >0.05 4.78 0.99 4.82 0.94 0.16 >0.05
Total 43.80 6.08 50.87 5.02 5.02 <0.05 47.17 5.16 52.00 5.94 3.31 <0.05

The pre and post-test knowledge score difference about the disease was not found to be statistically significant in relation to extraneous variables of age, education and severity of illness. Intervention group apparently had shown higher knowledge score than the control group but the pre-test knowledge regarding various aspects of tuberculosis among the two groups was not found to be significant except regarding side effects of drugs and complications of Tuberculosis (Table II).

Patients in the control group (taking DOTS therapy only) had shown marked increase in the knowledge about tuberculosis regarding its cause, spread and prevention, location and clinical features, side effects of drugs and complications. There was a significant improvement in the overall knowledge about the disease.

The patients in intervention group (taking DOTS therapy with use of health education booklet) also showed significant overall increase in the knowledge about tuberculosis especially regarding cause, spread and prevention and side effects of drugs and complications of tuberculosis. There was no significant improvement in this group regarding predisposing factors, location and clinical features as well as early detection and screening of pulmonary tuberculosis.

Intervention group did not show any significant difference in increase in the knowledge about tuberculosis in the post-test knowledge when compared to control group.

Discussion:

The present study consisted of all males serving soldiers. Thus the sex difference regarding knowledge about tuberculosis could not be ascertained. In the present study, age, education and severity of illness were not significantly associated with increase in the knowledge about tuberculosis. Malhotra et al3 have observed a poor level of knowledge about tuberculosis among female and illiterate population. Significantly higher proportion of individuals with age more than 40 years were aware of the correct mode of transmission of tuberculosis. Purohit4 also reported poor knowledge about tuberculosis among illiterates. The difference observed in the present study was due to population under study being only males with only 3.3% being illiterate.

The pre-test mean knowledge score was low regarding location and clinical features when compared with other studies3,5. It was coupled with lack of knowledge in identifying the disease which needed to be addressed to improve the passive case finding. The low awareness about early detection and screening of Pulmonary Tuberculosis might lead to harbouring of misconceptions about the treatment and cure of disease which may affect the early reporting of patients.

It was encouraging to observe in the present study that a high pretest mean knowledge score regarding side effects of drugs and complications of Pulmonary Tuberculosis may help in early reporting and proper management of cases thereby reducing the mortality. Most of the patients tend to stop medication as soon as they felt better and would not tell anyone. Thus all the patients hospitalized at the start of the treatment should adequately receive the instructions about the use and importance of drugs from drug providers thus making them more compliant. Therefore, there is a scope for an active nursing role in psycho-educational intervention.

The low pre-test knowledge in both the groups concerning health practices and life styles stresses the importance of mass media, health care workers, friends/relatives, other people in the community to bring about a positive change in the practices of people regarding tuberculosis. Despite the availability of effective treatment, there has been a failure to control tuberculosis in most developing countries and, therefore, research should aim at reducing inadequacies of methods of treatment administration and supervision.

Through there was a significant improvement in pre and post test knowledge score in both the groups regarding cause, spread and prevention and side effects of drugs and complications of pulmonary TB but there was no significant improvement as far as health practices and life styles and early detection and screening was concerned. DOTS chemotherapy alone was found to have significant improvement in post test knowledge score regarding location and clinical features where additional health education through booklet seems to have no role to play.

Although there was a significant improvement in mean knowledge score about tuberculosis in post tests in both the groups but the effect of health education booklet on the knowledge of tuberculosis was not statistically apparent thereby suggesting not much emphasis be laid on such materials. This is in comparison to study by Subramanian5 where an increase of knowledge on various aspects of TB, ranging from 18 to 58% was observed using pamphlets, filmshows, exhibition, role plays and group discussions. Admittedly the study was confined to specific group in hospital set up covering limited subjects.

Conclusion:

Though there was a significant improvement in post test mean knowledge score in both the groups but health education material was not found to have any additional significant improvement in self knowledge and awareness about tuberculosis. Any long term therapy needed positive approach and thus required an adequate basic knowledge about disease and importance of regular treatment for cure. Drug providers can play an important role in hospitalized patients in imparting instructions about the use and importance of drugs thereby improving patient compliance to treatment.

References:

  1. WHO: DOTS-TB cure for all. New Delhi: World Health Organisation, 2001: 2-5.
  2. Park K. Park's Text Book of Preventive and Social Medicine. Jabalpur M/S Banarasidas Bhanot, 2000: 310
  3. Malhotra R, Taneja DK, Dhingra VK, Rajpal S, Mehra M. Awareness regarding tuberculosis in a rural population of Delhi, Indian Journal Community Medicine, Apr-Jun 2002; 27(2): 62-8.
  4. Purohit SD, Gupta ML, Madan A, Gupta PR, Mathur BB, Sharma TN. Awareness about tuberculosis among general population : A pilot study. Ind J Tub 1988; 35: 183-7.
  5. Subramanian T, Charles N, Balasubramanian R, Balambal R, Sundram V, Ganapathy S et al. Knowledge of tuberculosis in a south Indian rural community, initially and after health education. Ind J Tub, 1999; 46(4): 251-4.
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