Study finds education improves compliance

Intervention includes photo novella

When it comes to getting patients to complete their TB drug regimens, health education works better than incentives, Los Angeles TB researchers reported at the First International Conference on Emerging Infectious Diseases in Atlanta.

In a descriptive study of patients receiving treatment for TB at two public health clinics in Los Angeles, researchers randomized patients into three treatment groups: One group was given educational counseling, a second group was given incentive rewards for compliant behavior, and the third was given a combination of educational counseling and incentives.

The patients, who were primarily male Hispanics and had a median age of 32, were followed for the course of their treatment program. The study's outcome measures were the percentage of patients who successfully completed their course of treatment and the cost-effectiveness of the intervention programs.

The study found that patients randomized to the educational counseling intervention were significantly more likely to take their medication and complete their regimen than those who received incentive rewards only, says Donald Morisky, ScD, MSPH, the lead author and researcher at the UCLA School of Medicine.

The educational components included a photo novella - story pictures using photos of volunteer patients and staff that illustrate several TB treatment principles presented in language patients understand. Patients also were exposed to posters and given handouts that instilled in them the importance of proper medication-taking behaviors, particularly in the absence of symptoms, as well as the need for social reinforcement.

"Stigma is a big problem in TB, and one of the incidences we found in our focus groups is that the elderly are not being visited by their children and grandchildren because they are afraid grandma has TB," Morisky tells TB Monitor. "So it is important to extend your message to the family to let them know [treated] TB is no longer contagious, and they can assist in helping in giving medication and reminding a patient to take it."

The study follows an earlier study with the same design in which the same results were found. In that study, however, the interventions and controls took place within the same clinic, raising concern that the results were contaminated, Morisky adds.