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Exploratory, cross-sectional social network study to assess the influence of social networks on the care-seeking behaviour, treatment adherence and outcomes of patients with tuberculosis in Chennai, India: a study protocol.

ABSTRACT: INTRODUCTION:Poor treatment adherence and outcomes among patients with tuberculosis (TB) lead to drug resistance, and increased risk of morbidity, mortality and transmission of the disease in the community. Individual patient-level psychological and behavioural risk factors and structural-level social and health system determinants of treatment adherence and outcomes had been studied widely in India and other countries. There is an evidence gap on how care-seeking behaviour, treatment adherence and outcomes of patients with TB are influenced by their social network structure and the different support they received from social network members. METHODS AND ANALYSIS:We propose an exploratory, cross-sectional social network study to assess the social network structure of patients with TB in Chennai who recently completed their treatment under the Revised National Tuberculosis Control Program in India. We will employ egocentric personal social network survey to 380 patients with TB to generate their social network relationships and will retrospectively assess the types of support they received from different network members. Support received will be categorised as emotional support, resources support, appraisal support, informational support, spiritual support, occupational support and practical support. Social network size, composition, density, centrality and cohesion for individual patients with TB will be calculated and sociograms will be developed. Multinomial logistic regressions will be used to assess the relationship between the 'structure of social network members' and 'social network supports' and the differential treatment-seeking behaviour, treatment adherence and outcomes among patients with TB. ETHICS AND HUMAN PROTECTION:The proposal was approved by the Institutional Review Board and Ethics Committee of the School of Public Health, SRM University in Kancheepuram. Confidentiality and privacy of participants will be protected. Duty of care for patients who have not completed treatment will be ensured by taking all possible measures to bring them back for treatment.

SUBMITTER: Nagarajan K

PROVIDER: S-EPMC6530515 | biostudies-literature | 2019 May

REPOSITORIES: biostudies-literature

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Exploratory, cross-sectional social network study to assess the influence of social networks on the care-seeking behaviour, treatment adherence and outcomes of patients with tuberculosis in Chennai, India: a study protocol.

Nagarajan Karikalan K Das Bagavan B

BMJ open 20190519 5

<h4>Introduction</h4>Poor treatment adherence and outcomes among patients with tuberculosis (TB) lead to drug resistance, and increased risk of morbidity, mortality and transmission of the disease in the community. Individual patient-level psychological and behavioural risk factors and structural-level social and health system determinants of treatment adherence and outcomes had been studied widely in India and other countries. There is an evidence gap on how care-seeking behaviour, treatment ad ...[more]

PMID: 31110090

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Project description:IntroductionA substantial share of urban Indians with diagnosed hypertension do not take regular treatment, potentially due to poor knowledge of hypertension consequences and treatment options. We describe hypertension knowledge and beliefs, treatment patterns, and reported reasons for treatment non-use among adults with diagnosed hypertension in Chennai, India.MethodsWe collected data on 833 adults ages 30+ with physician diagnosed hypertension using a door-to-door household survey within randomly selected wards of Chennai. We described the proportion of individuals who were not taking daily medications and their reported reasons for not doing so. Next, we described individuals' knowledge of hypertension consequences and how to control blood pressure (BP) and assessed the association between knowledge and daily treatment use.ResultsOver one quarter (28% (95% CI 25% to 31%)) of diagnosed individuals reported not taking daily treatment. The largest proportion (18% (95% CI 16% to 21%)) were individuals who had discontinued prior treatment use. The primary reason individuals reported for non-daily use was that their BP had returned to normal. Just 23% (95% CI 20% to 26%) of individuals listed BP medications as the most effective way to reduce BP; however, these individuals were 11% points (95% CI 4% to 19%) more likely to take daily medications. Conversely, 43% (95% CI 40% to 47%) of individuals believed that BP medications should be stopped from time to time and these individuals were 15% points (95% CI -0.21 to -0.09) less likely to take daily treatment. While awareness of the consequences of hypertension was poor, we found no evidence that it was associated with taking daily medications.ConclusionsThere were large gaps in consistency of BP medication use which were strongly associated with knowledge about BP medications. Further research is needed to identify whether addressing beliefs can improve daily treatment use among individuals with diagnosed hypertension.

Project description:BackgroundPretreatment loss to follow-up (PTLFU) is a barrier to tuberculosis (TB) control in India's Revised National TB Control Programme (RNTCP). PTLFU studies have not been conducted in India's mega-cities, where patient mobility may complicate linkage to care.MethodsWe collected data from patient registries for May 2015 from 22 RNTCP designated microscopy centers (DMCs) in Chennai and audited addresses and phone numbers for patients evaluated for suspected TB to understand how missing contact information may contribute to PTLFU. From November 2015 to June 2016, we audited one month of records from each of these 22 DMCs and tracked newly diagnosed smear-positive patients using RNTCP records, phone calls, and home visits. We defined PTLFU cases as including: (1) patients who did not start TB therapy within 14 days and (2) patients who started TB therapy but were lost to follow-up or died before official RNTCP registration. We used multivariate logistic regression to identify factors associated with PTLFU.ResultsIn the audit of May 2015 DMC registries, out of 3696 patients evaluated for TB, 1273 (34.4%) had addresses and phone numbers that were illegible or missing. Out of 344 smear-positive patients tracked from November 2015 to June 2016, 40 (11.6%) did not start TB therapy within 14 days and 36 (10.5%) started therapy but were lost to follow-up or died before official RNTCP registration, for an overall PTLFU rate of 22.1% (95%CI: 17.8%-26.4%). Of all PTLFU patients, 55 (72.4%) were lost to follow-up and 21 (27.6%) died before starting treatment or before RNTCP registration. In the regression analysis, age?>?50 years (OR 2.9, 95%CI 1.4-6.5), history of prior TB (OR 3.9, 95%CI 2.2-7.1), evaluation at a high patient volume DMC (OR 3.2, 95% CI 1.7-6.3), and absence of legible patient contact information (OR 4.5, 95%CI 1.3-15.1) were significantly associated with PTLFU.ConclusionsIn an Indian mega-city, we found a high PTLFU rate, especially in patients with a prior TB history, who are at greater risk for having drug-resistance. Enhancing quality of care and health system transparency is critical for improving linkage of newly diagnosed patients to TB care in urban India.

Project description:ObjectiveThis study explored the illness experiences and healthcare-seeking behaviour of a cross-section of street dwellers of Dhaka City for designing a customised intervention.DesignA qualitative exploratory study of a sample of street dwellers of Dhaka City.SettingSamples were taken from three purposively selected spots of Dhaka City with a high concentration of the target population.ParticipantsFifteen in-depth interviews and six informal group discussions with 40 street dwellers (≥18 years), and key informant interviews with service providers (n=6) and policymakers (n=3) were conducted during January-June 2019 to elicit necessary data.Primary outcome measuresQualitative narrative of illness experiences of the sampled street dwellers, relevant healthcare-seeking behaviour and experiences of interactions with health systems.ResultsWe focused on three main themes, namely, reported illnesses, relevant healthcare-seeking behaviour and health system experiences of the street dwellers. Findings reveal that most of the street dwellers suffered from fever and respiratory illnesses in the last 6 months; however, a majority did not visit formal facilities. They preferred visiting retail drug shops for advice and treatment or waited for self-recovery. Formal facilities were visited only when treatment from drug shops failed to cure them or they suffered serious illnesses or traumatic injury. The reproductive-age women did not seek pregnancy care and most deliveries took place in the street dwellings. Lack of awareness, financial constraints and fear of visiting formal facilities were some of the reasons mentioned. Those who visited formal facilities faced barriers like the cost of medicines and diagnostic tests, long waiting time and opportunity cost.ConclusionsThe street dwellers lacked access to formal health systems for needed services as the latter lags far behind to outreach this extremely vulnerable population. What they need is explicit targeting with a customised package of services based on their illness profile, at a time and place convenient to them with minimum or no cost implications.

Project description:BackgroundIndia has the greatest burden of tuberculosis (TB). However, over 15% of the people on antitubercular therapy (ATT) in India are nonadherent. Several adherence monitoring techniques deployed in India to enhance ATT adherence have had modest effects. Increased adoption of mobile phones and other technologies pose potential solutions to measuring and intervening in ATT adherence. Several technology-based interventions around ATT adherence have been demonstrated in other countries.ObjectiveThe objective of our study was to understand the acceptance of mobile phone adherence supports for ATT using self-administered quantitative measures among patients with TB in South India.MethodsThis exploratory study was conducted at a TB treatment center (TTC) at a tertiary care center in Thrissur District, Kerala, India. We recruited 100 patients with TB on ATT using convenience sampling after obtaining written informed consent. Trained study staff administered the questionnaire in Malayalam, commonly spoken in Kerala, India. We used frequency, mean, median, and SD or IQR to describe the data.ResultsOf the 100 participants diagnosed with TB on ATT, 90% used mobile phones routinely, and 84% owned a mobile phone. Ninety-five percent of participants knew how to use the calling function, while 65% of them did not know how to use the SMS function on their mobile phone. Overall, 89% of the participants did not consider mobile phone-based ATT adherence interventions an intrusion in their privacy, and 93% did not fear stigma if the adherence reminder was received by someone else. Most (95%) of the study participants preferred mobile phone reminders instead of directly observed treatment, short-course. Voice calls (n=80, 80%) were the more preferred reminder modality than SMS reminders (n=5, 5%).ConclusionsMobile phones are likely an acceptable platform to deliver ATT adherence interventions among individuals with TB in South India. Preference of voice call reminders may inform the architecture of future adherence interventions surrounding ATT in South India.

Project description:BackgroundEarly diagnosis of tuberculosis (TB) and involvement of the public-private partnership are critical to eradicate TB. Patients need to receive proper treatment through the National Tuberculosis Control Programme (NTP). This study describes various predictors for health seeking behaviour of TB patients and health system delay made by the different health care providers.MethodsA cross-sectional study was conducted in a public health facility of a rural area in Bangladesh. Newly diagnosed smear positive pulmonary TB (PTB) patients who were ≥ 15 years of age were sequentially enrolled in this study. The socio-demographic characteristics and proportion of health care utilization by the patients, and health system delay made by the health care providers were calculated. Multivariate analysis was conducted to determine the independent association of the risk factors with the time to seek medical care.ResultsTwo hundred and eighty patients were enrolled in this study. Among them, 73.6% were male and 26.4% were female. A hundred percent of patients primarily sought treatment for their cough, 170 (60.7%) first consulted a non-qualified practitioner while 110 patients (39.3%) first consulted with qualified practitioners about their symptoms. Pharmacy contact was the highest (27.9%) among the non-qualified practitioners, and 58.9% non-qualified practitioners prescribed treatment without any laboratory investigation. The average health system delay was 68.5 days. Multiple logistic regressions revealed a significant difference between uneducated and educated patients (OR 2.33; CI 1.39-3.92), and qualified and non-qualified practitioners (OR 2.34; CI 1.38-3.96) to be independent predictors of health system delay.ConclusionsCompared to men, fewer women sought TB treatment. Uneducated patients and questionably qualified practitioners made for a longer delay in detecting TB. Increasing public health awareness and improving health seeking behavior of females and uneducated patients, and greater participation of the qualified practitioners in the NTP are highly recommended.

Dataset Information

Exploratory, cross-sectional social network study to assess the influence of social networks on the care-seeking behaviour, treatment adherence and outcomes of patients with tuberculosis in Chennai, India: a study protocol.

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Exploratory, cross-sectional social network study to assess the influence of social networks on the care-seeking behaviour, treatment adherence and outcomes of patients with tuberculosis in Chennai, India: a study protocol.

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