Effectiveness of Intensive Health Education on Tuberculosis Awareness, Attitude and Practice on Pulmonary Tuberculosis among Patients with Pulmonary Tuberculosis

 

T. Nanthini1, Karaline Karunagari2

1Associate Professor in Nursing, CON, MTPG & RIHS.

2RMCON, Annamalai University, Chidambaram.

*Corresponding Author E-mail: nandhinilecturer@gmail.com

 

 

ABSTRACT:

Tuberculosis is an infectious disease which spreads from one person to another which has a devastating impact on the economic well-being of the individual, their families, and the entire community. The effective engagement of all health care providers especially nursing personnel, play an important role to scale up and commensurate to their presence to achieve universal access to tuberculosis care. Majority of times, the nursing personnel were the first person to be contacted, to take care of the patients with tuberculosis. The aim of the study is to evaluate the effectiveness of intensive health education on Pulmonary tuberculosis among patients with newly diagnosed Pulmonary tuberculosis from the four primary health centres as Mettupalayam, Lawspet, Reddiarpalayam and Mudaliarpet under RNTCP (April 2017-February 2018), in Puducherry. The objectives of the study is to assess the tuberculosis awareness, attitude and practice of the subjects among the experimental and control group before and after the intervention, to evaluate the effectiveness of intensive health education and to find out the association between the pretest level of tuberculosis awareness, attitude and practice of the subjects with selected demographic variables. Pre experimental study was adopted. For the purpose of this study, a total of 126 subjects of newly diagnosed pulmonary tuberculosis were under RNTCP(October 2016 to February 2018) selected from the four primary health centres by using cluster stage sampling technique. The investigator explained the purpose of the study to the subjects. The pretest was conducted by using the interview method for all the subjects following that implementation of nursing strategies as intensive health education on health promotion and management of pulmonary tuberculosis, distribution of self-instructional module. Continuous follow up of the subjects every week till 2 months and the posttest-I was conducted by using the same questionnaire after 2 months i.e. end of the intensive phase and again posttest-II was conducted by using the same questionnaire after 6 months i.e. at the end of the continuous phase. The findings of the study as out of 126 subjects, the mean score of tuberculosis awareness score was 9.04±3.65 in the experimental group and 8.32±3.13 of them in the control group. The mean score of attitude towards tuberculosis was 28.38±4.60 and 29.72±5.05 of them in the control group. The mean level of tuberculosis awareness score in the experimental group was 9.04 during pretest and increased to 19.13 in posttest I and further increased to 21.57 in posttest II. But in the control group, the mean tuberculosis awareness score was 8.32 during the pretest and increased to 14.50 in posttest I and 14.84 in posttest II which indicated that there was an increase in the level of tuberculosis awareness score from pretest to posttest II in the experimental group which was significant at p<0.001 level. The mean attitude score in the experimental group was 28.38 during the pretest and increased to 46.80 in posttest I and 57.41 in posttest II and in the control group 29.72 during the pretest and increased to 29.19 in posttest I and 32.24 in posttest II which indicated there was increase in the level of attitude score which was statistically significant at p<0.001 level. The mean practice score in the experimental group was 13.97 during pretest and increased to 20.51 in posttest I and 24.51 in posttest II and in control group 13.51 during the pretest and increased to 18.69 in posttest I and 17.53 in posttest II. The mean values clearly indicated that there was an increase in the practice score which was statistically significant at p<0.001 level. The increased level of Knowledge, attitude and practice score which confirmed that the intervention was much effective in the experimental group when compared to the control group. The Kruskal-Wallis test revealed that there was a significant association between the tuberculosis awareness score of the subjects with selected demographic variables such as the source of information heard about DOTS was statistically significant at p<0.05 level, attitude score of the subjects with selected demographic variable as a marital status which was significant at p<0.05 level than other variables and the practice score of the subjects with gender which was highly significant at p<0.05 level. They concluded that the treatment outcome of the subjects under RNTCP was cured and the cure rate is 100% both in the experimental group and in the control group. Nursing strategies as intensive health education, self-care module along with anti tuberculosis drugs were found to be more effective in improving the tuberculosis awareness, attitude, practice of the subjects in the experimental group than the control group.

 

KEYWORDS: Effectiveness, Intensive Health Education, Tb Awareness, attitude and practice, pulmonary tuberculosis.

 


INTRODUCTION:

Tuberculosis is an infectious disease which spreads from one person to another which has a devastating impact on the economic well-being of the individual, their families, and the entire community. The End TB Strategy milestones for 2020 to 2025 can only be achieved if tuberculosis diagnosis, treatment, and prevention services are provided towards Universal Health Coverage (UHC). There is a multisectoral action to address the social and economic factors that drive tuberculosis epidemics. Tuberculosis incidence needs to be reduced by 10% per year within 2025, and the proportion of people with tuberculosis who die from the disease needs to fall by 6.5% within 2025. UHC means that everyone irrespective of their living standards receives the health services they need and each one will be able to use the health services without much of financial hardship (Global TB Report, 2018).

 

Jacintha (2003) identified that the intensive health education was effective in improvement of the treatment adherence among patient with newly diagnosed pulmonary tuberculosis. The effective engagement of all health care providers especially nursing personnel, play an important role to scale up and commensurate to their presence to achieve universal access to tuberculosis care. Majority of times, the nursing personnel were the first person to be contacted, to take care of the patients with tuberculosis. Since the inception of RNTCP, multiple prior interventions through various strategies have been deployed to engage NGOs and private providers for tuberculosis control efforts in reducing the tuberculosis mortality.

 

Many people with tuberculosis disease were hesitant to access the treatment, as they had fear of being discriminated and isolated from their community.


Therefore the patients with tuberculosis and their families need to be educated regarding the consequences of incomplete/irregular tuberculosis treatment which could lead to the development of drug resistant tuberculosis and which may require health education and ongoing counseling to motivate them towards strict adherence to tuberculosis drug regimen, thereby their quality of life will be improved.

 

STATEMENT OF THE PROBLEM:

A study to evaluate the effectiveness of intensive health education on Pulmonary tuberculosis among patients with newly diagnosed Pulmonary tuberculosis in selected Primary Health Centres under RNTCP, in Puducherry.

 

OBJECTIVES OF THE STUDY:

1.         To assess the tuberculosis awareness, attitude and practice of the subjects among the experimental and control group before intervention.

2.         To evaluate the effectiveness of intensive health education on tuberculosis awareness, attitude and practice of the subjects in the experimental and control group after intervention.

3.         To find out the association between the pretest level of tuberculosis awareness, attitude and practice of the subjects with selected demographic variables.

 

HYPOTHESES OF THE STUDY:

H1: There is a significant difference in tuberculosis awareness, attitude and in the practice of the subjects between experimental group and the control group before and after the intervention.

H3: There is a significant association between the tuberculosis awareness, attitude and practice of the subjects with selected demographic variables.

 

MATERIALS AND METHOD:

Pre experimental study was adopted for the study. For the purpose of this study, a total of 126 subjects of newly diagnosed pulmonary tuberculosis were selected from the four primary health centres by using cluster stage sampling technique. The investigator explained the purpose of the study to the subjects. The pretest was conducted by using the interview method for all the subjects following that implementation of nursing strategies as intensive health education on health promotion and management of pulmonary tuberculosis, distribution of self instructional module. Continuous follow up of the subjects every week till 2 months and the posttest-I was conducted by using the same questionnaire after 2 months i.e. end of the intensive phase and again posttest-II was conducted by using the same questionnaire after 6 months i.e. at the end of the continuous phase.

 

RESULTS AND DISCUSSION:

Out of 126 subjects, the demographic variables of the subjects as

·                 Nearly 38.2% of the subjects in experimental group and 34.5% of them in control group were between the age group of 30-45 years and 39.7% of them in experimental group and 34.5% of them in control group were above 45 years. Most of the subjects 50(73.5%) were males, suffering from pulmonary tuberculosis in the experimental group and 37(63.8%) of them, in the control group. Around 61(89.7%) of them in the experimental group were Hindus and 49(84.5%) of them in the control group. Most of the subjects 45(66.1%) in the experimental group belonged to the upper lower class (class IV) and 34(58.6%) in control group.

 

·           Most of the subjects 43(63.2%) were alcoholic in the experimental group and 35(60.3%) of them in the control group. Nearly 33(48.5%) of them were smokers in the experimental group and 26(44.8%) of them in the control group.

 


Tuberculosis Awareness, Attitude and Practice Score of the Subjects before and after Intervention:

 

Table 1 Mean and Standard Deviation of Tuberculosis Awareness Score of the Subjects Group and Assessment Wise                    (N = 126)

Tuberculosis Awareness

Mean

SD

ANOVA repeated measure test value

Repeated Contrast test value

Comparison

F value

p value

F-value

P value

Experimental Group

Pretest

9.04

3.65

415.42

<0.001** (S)

Pretest vs Posttest I

364.10

<0.001** (S)

Posttest I

19.13

2.65

Posttest I vs posttest II

48.76

<0.001** (S)

Posttest II

21.57

1.29

Control Group

Pretest

8.32

3.13

 

126.08

 

<0.001** (S)

Pretest vs Posttest I

137.76

<0.001** (S)

Posttest I

14.50

2.90

Posttest I vs posttest II

1.57

0.214 (NS)

Posttest II

14.84

2.90

**Significant at p< 0.001 level                                                              NS Non Significant

 

Table 2 Mean and Standard Deviation of Attitude Score of the Subjects by Group and Assessment Wise                       (N = 126)

Groups

Attitude

Mean

SD

ANOVA repeated measure test value

Repeated Contrast test value

Comparison

F

value

p value

F-value

P value

Experimental Group

Pretest

28.38

4.60

12435.13

<0.001** (S)

Pretest vs Posttest I

391.96

<0.001** (S)

Posttest I

46.80

6.69

Posttest I vs posttest II

188.01

<0.001**(S)

Posttest II

57.41

2.78

Control Group

Pretest

29.72

5.05

 

4289.84

<0.001** (S)

Pretest vs Posttest I

0.368

<0.547(NS)

Posttest I

29.19

4.83

Posttest I vs posttest II

34.79

<0.001**(S)

Posttest II

32.24

4.68

**Significant at p< 0.001 level                                                              NS Non Significant


 

Table 1 shows the mean and standard deviation of the tuberculosis awareness score of the subjects group wise and assessment wise. From the above two findings, it was concluded that both experimental and control groups were effective in increasing the level of tuberculosis awareness of the subjects.


Table 2 shows the mean and standard deviation of the attitude of the subjects group wise and assessment wise. From the above two findings, it was concluded that both experimental and control groups were effective as there was an increase in the level of attitude score of the subjects.


 

Table 3 Mean and Standard Deviation of Practice Score of the Subjects by Group and Assessment Wise (N = 126)

Groups

Practice

Mean

SD

ANOVA repeated measure test value

Repeated Contrast test value

Comparison

F

value

p value

F-value

P value

Experimental Group

Pretest

13.97

1.46

876.802

<0.001** (S)

Pretest vs Posttest I

286.56

<0.001** (S)

Posttest I

20.51

3.08

Posttest I vs posttest II

80.99

<0.001** (S)

Posttest II

24.51

4.52

Control Group

Pretest

13.51

1.45

 

771.507

 

<0.001** (S)

Pretest vs Posttest I

405.21

<0.005* (S)

Posttest I

18.69

1.73

Posttest I vs posttest II

29.48

<0.001** (S)

Posttest II

17.53

2.11

*Significant at p< 0.05 level                                                    NS Non Significant

**Significant at p< 0.001 level


 


Table 3 shows the mean and standard deviation of the practice score of the subjects group wise and assessment wise. From the above two findings, it was concluded that both experimental and control groups were effective to increase the practice score of the subjects.

 

DISCUSSION:

Tuberculosis Awareness Score of the Subjects after Intervention:

In current study during pretest majority of the subjects in the experimental group 77.9% had inadequate knowledge and 84.5% of them in the control group. In posttest I after interventions, majority of the subjects had adequate knowledge (82.4%) in the experimental group and 69% of the subjects had moderately adequate knowledge in the control group. Again In the posttest II, all of the subjects had adequate knowledge in experimental group and 31% of them in the control group had inadequate knowledge about tuberculosis. Therefore, it was evident that the nursing interventions were effective in improving the tuberculosis awareness among the experimental group when compared to the control group. Education about tuberculosis were more likely to have good level of overall knowledge about tuberculosis among the subjects with tuberculosis. These findings were congruent with the findings of studies conducted in Ethiopia (Bati, et al., 2013), Vietnam (Hoa, et al., 2009), Nigeria (Agho, et al., 2014) and US and Canada (Colson, et al., 2014).

 

The present study showed that the total health status of subjects improved significantly after receiving intensive health education and medication. Balasangameshwara, et al. (1996) stated that persistence of symptoms in subjects treated with short course had difference in the posttest knowledge scores of Chemotherapy (SCC) which was less common than in subjects who received intensive health education and they were compared with those who did not receive intensive health education. Subramanian, et al. (1999) found an overall increase in knowledge after health education, on various aspects of tuberculosis, ranging from 18% to 58%, after health education.

 

Attitude Score of the Subjects after Intervention:

In this study, during the pretest, most of the subjects (86.7%) in the experimental group had unfavourable attitude and 77.5% of in the control group had unfavourable attitude towards their illness. In posttest I, 82.7% of the subjects in the control group had uncertain attitude towards tuberculosis and in the experimental group 86.7% of the subjects had uncertain attitude towards tuberculosis. But in the posttest II after reinforcement, most of the subjects 97.1% had favourable attitude towards tuberculosis in the


experimental group and 70.6% of them in control group had unfavourable attitude towards tuberculosis at the end of 6 months after completion of the course of treatment which was significant at p<0.001 level between the experimental and control group with regard to their level of attitude towards tuberculosis. Therefore, it was evident that the intervention was very effective in improving the attitude of the subjects towards tuberculosis. Study done by Zhiping, et al. (2016) quoted that the subjects with tuberculosis with indifferent attitude had significantly longer treatment delay and improvement of subjects with tuberculosis’ attitude prevents the emergence of tuberculosis, especially MDR-TB. Changing their unfavourable attitude to favourable attitude towards tuberculosis, can potentially influence subjects with tuberculosis' decision in health seeking behaviour and adherence to tuberculosis treatment (Cramm, et al., 2010). Even in the present study change in the attitude of the subjects had increased their health seeking behaviour.

 

Practice Score of the Subjects after the Intervention:

The present study found that during the pretest, most of the subjects 91.2% in the experimental group had inadequate practice and 87.9% of them in control group had inadequate practice before the intervention in both groups. In posttest I, 97.1% of the subjects in the experimental group had adequate practice and 98.3% of them had adequate practice in the control group. In posttest II, in 99% and 100% of the subjects in the experimental group and control group had adequate practice which was similar. It was evident that the intervention was very effective in promotion of the subjects’ practice towards tuberculosis. Satyanarayana, et al., (2015) stated that community-based programs was        effective     in improving the practice regarding tuberculosis among young people and less educated groups.

 

MAJOR FINDINGS OF THE STUDY:

Pretest Level of Tuberculosis Awareness, Attitude and Practice:

·           The mean score of tuberculosis awareness score was 9.04±3.65 in the experimental group and 8.32±3.13 of them in the control group. The mean score of attitude towards tuberculosis was 28.38±4.60 and 29.72±5.05 of them in the control group. The mean practice score of the subjects was 13.97 ± 1.46 in the experimental group and 13.51±1.45 in the control group. There was no significant difference exists between the two groups which inferred that the subjects’ tuberculosis awareness, attitude and practice was similar and found to be comparable in both the groups before intervention.


 

Tuberculosis Awareness Score of the Subjects after Intervention:

·                 The mean level of tuberculosis awareness score in the experimental group was 9.04 during pretest and increased to 19.13 in posttest I and further increased to 21.57 in posttest II. But in the control group, the mean tuberculosis awareness score was 8.32 during the pretest and increased to 14.50 in posttest I and 14.84 in posttest II which indicated that there was an increase in the level of tuberculosis awareness score from pretest to posttest II in the experimental group which was significant at p<0.001 level. The findings confirmed that the intervention was much effective in increasing the level of tuberculosis awareness among the subjects in the experimental group than the control group.

 

Attitude Score of the Subjects after Intervention:

·                 The mean attitude score in the experimental group was 28.38 during the pretest and increased to 46.80 in posttest I and 57.41 in posttest II and in the control group 29.72 during the pretest and increased to 29.19 in posttest I and 32.24 in posttest II which indicated there was increase in the level of attitude score which was statistically significant at p<0.001 level. The increased level of attitude score was statistically significant at p<0.001 level which confirmed that the intervention was much effective in increasing the level of attitude score of the subjects in the experimental group.

 

Practice Score of the Subjects after Intervention:

·                 The mean practice score in the experimental group was 13.97 during pretest and increased to 20.51 in posttest I and 24.51 in posttest II and in control group

13.51 during the pretest and increased to 18.69 in posttest I and 17.53 in posttest II. The mean values clearly indicated that there was an increase in the practice score which was statistically significant at p<0.001 level and the increased level of practice score which confirmed that the intervention was much effective in the experimental group in increasing the practice score when compared to the control group.

Association of Pretest Tuberculosis Awareness, attitude and practice Score of the Subjects with Selected Demographic Variables:

·                 The Kruskal-Wallis test revealed that there was a significant association between the tuberculosis awareness score of the subjects with selected demographic variables such as the source of information heard about DOTS was statistically significant at p<0.05 level, attitude score of the subjects with selected demographic variable as a marital status which was significant at p<0.05 level than other variables and the practice score of the subjects with gender which was highly significant at p<0.05 level.

 

CONCLUSION:

The following conclusions were drawn from the study

·           Treatment outcome of the subjects under RNTCP was cured and the cure rate is 100% both in the experimental group and in the control group.

·           Nursing strategies as intensive health education, self- care module along with anti-tuberculosis drugs were found to be more effective in improving the tuberculosis awareness, attitude, practice of the subjects in the experimental group than the control group.

·           The present study shows that there was a statistically significant association between the pretest knowledge with source of information as heard about DOTS, attitude score with marital status and practice score with gender. But ANCOVA test revealed that these- variable had no influence over the effectiveness of the intervention.

RECOMMENDATIONS:

Based on the findings of the present study, the following recommendations are made

·           The study can be replicated using a large sample to validate the findings and make generalizations.

·           A comparative study can be conducted among the case (tuberculosis) and control group (Non- tuberculosis).

·           A follow-up study can be conducted to evaluate the effectiveness of nursing strategies.

 

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Received on 24.06.2021                Modified on 07.07.2021

Accepted on 17.07.2021            © AandV Publications all right reserved

Int. J. Nur. Edu. and Research. 2021; 9(4):461-466.

DOI: 10.52711/2454-2660.2021.00106