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

BACKGROUND:Treatment 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...

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Main Authors: Habteyes Hailu Tola, Davoud Shojaeizadeh, Azar Tol, Gholamreza Garmaroudi, Mir Saeed Yekaninejad, Abebaw Kebede, Luche Tadesse Ejeta, Desta Kassa, Eveline Klinkenberg
Format: Article
Language:English
Published: Public Library of Science (PLoS) 2016-01-01
Series:PLoS ONE
Online Access:http://europepmc.org/articles/PMC4864292?pdf=render
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spelling doaj-30eb20eb3405497c99b18e37ad47d3222020-11-25T01:17:00ZengPublic Library of Science (PLoS)PLoS ONE1932-62032016-01-01115e015514710.1371/journal.pone.0155147Psychological and Educational Intervention to Improve Tuberculosis Treatment Adherence in Ethiopia Based on Health Belief Model: A Cluster Randomized Control Trial.Habteyes Hailu TolaDavoud ShojaeizadehAzar TolGholamreza GarmaroudiMir Saeed YekaninejadAbebaw KebedeLuche Tadesse EjetaDesta KassaEveline KlinkenbergBACKGROUND:Treatment 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). METHODOLOGY:A 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. RESULTS:At 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)). CONCLUSION:Psychological 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 REGISTRATION:Pan African Clinical Trials Registry PACTR201506001175423.http://europepmc.org/articles/PMC4864292?pdf=render
collection DOAJ
language English
format Article
sources DOAJ
author Habteyes Hailu Tola
Davoud Shojaeizadeh
Azar Tol
Gholamreza Garmaroudi
Mir Saeed Yekaninejad
Abebaw Kebede
Luche Tadesse Ejeta
Desta Kassa
Eveline Klinkenberg
spellingShingle Habteyes Hailu Tola
Davoud Shojaeizadeh
Azar Tol
Gholamreza Garmaroudi
Mir Saeed Yekaninejad
Abebaw Kebede
Luche Tadesse Ejeta
Desta Kassa
Eveline Klinkenberg
Psychological and Educational Intervention to Improve Tuberculosis Treatment Adherence in Ethiopia Based on Health Belief Model: A Cluster Randomized Control Trial.
PLoS ONE
author_facet Habteyes Hailu Tola
Davoud Shojaeizadeh
Azar Tol
Gholamreza Garmaroudi
Mir Saeed Yekaninejad
Abebaw Kebede
Luche Tadesse Ejeta
Desta Kassa
Eveline Klinkenberg
author_sort Habteyes Hailu Tola
title Psychological and Educational Intervention to Improve Tuberculosis Treatment Adherence in Ethiopia Based on Health Belief Model: A Cluster Randomized Control Trial.
title_short Psychological and Educational Intervention to Improve Tuberculosis Treatment Adherence in Ethiopia Based on Health Belief Model: A Cluster Randomized Control Trial.
title_full Psychological and Educational Intervention to Improve Tuberculosis Treatment Adherence in Ethiopia Based on Health Belief Model: A Cluster Randomized Control Trial.
title_fullStr Psychological and Educational Intervention to Improve Tuberculosis Treatment Adherence in Ethiopia Based on Health Belief Model: A Cluster Randomized Control Trial.
title_full_unstemmed Psychological and Educational Intervention to Improve Tuberculosis Treatment Adherence in Ethiopia Based on Health Belief Model: A Cluster Randomized Control Trial.
title_sort psychological and educational intervention to improve tuberculosis treatment adherence in ethiopia based on health belief model: a cluster randomized control trial.
publisher Public Library of Science (PLoS)
series PLoS ONE
issn 1932-6203
publishDate 2016-01-01
description BACKGROUND:Treatment 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). METHODOLOGY:A 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. RESULTS:At 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)). CONCLUSION:Psychological 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 REGISTRATION:Pan African Clinical Trials Registry PACTR201506001175423.
url http://europepmc.org/articles/PMC4864292?pdf=render
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