IMPACT OF HEALTH EDUCATION ON TUBERCULOSIS DRUG ADHERENCE;

    

ABSTRACT Adherence is defined as the extent to which patients follow the instructions they are given for prescribed treatments. Until recently, adherence expertise was hard to find, assemble and empower. The study shall solely aim at investigating the influence of patients’ health education on Tuberculosis drug adherence. It will be guided by the following specific objectives; to identify the level of adherence among TB patients at MTRH, to assess the level of patient’s health education on TB drugs, to identify barriers of TB education, to investigate the challenges facing TB patients on treatment and to determine the level of training given to health workers on TB drug adherence. These objectives will enable the researcher to elaborate more on the topic and ensure that those who read through this research shall have a better perspective on the effects of health education on tuberculosis drug adherence. It will take place between the months of July and August. The study will target 17 doctors, 119 nurses and 143 patients of Tuberculosis. The study will employ a case study research design. The case study will enable the researcher be able to collected detailed information as to the influence of patients’ health education on TB drug adherence. The study will employ purposive sampling to sample the doctors and simple random sampling to select both the nurses and the patients who will participate in the study. The researcher will use one research instrument to collect data from the respondents selected to participate in the study which is a questionnaire that will be issued to the respondents on the day of the data collection.

CHAPTER ONEINTRODUCTION

This chapter introduces the study and it will consist of the background of the study, statement of the problem, the objectives of the study, research questions, scope and significance of the study as well as the limitations of the study.

Background of the studyAdherence is defined as the extent to which patients follow the

instructions they are given for prescribed treatments. Until recently, adherence expertise was hard to find, assemble and empower. Pleio Health Support Systems began bringing people together to create an adherence solution in 2006. They have worked closely with innovative pharmacy chains, pharmaceutical manufacturers and more than a dozen technology and database providers, to build a platform that provides patients a variety of medication adherence support services when they need them, how they want them and where they want them. Pleio Good Start offers a variety of resources to help people get off to a good start on new prescriptions, so that they can get the most of their medication (Garner, 2000).

Around the world, for most patients, getting a good start with a new medication is easier said than done: accepting their disease, understanding dosing instructions and creating a new habit are just a few of the barriers that await them after they have left the pharmacy, prescription in hand. Inhaled and injected medications can be challenging to administer properly, but even blood pressure pills can become a low priority when people do not understand how they work or what they do. For most people, there is no silver bullet that will suddenly cause them to become completely compliant, as adherence is a complex process (Melbourne, 2000).

Prescription refill records prove that the first few months on a new medication are the most challenging. In fact, Pleio Health Support Systems has observed that, for many drugs, most patients become non-compliant with dosing instructions within just 5 days of picking up their prescription. So connecting with patients as soon as they fill their first prescription and staying with them during the adoption phase is a good fit for pharmacists, who normally see patients more than any other healthcare provider during this critical adoption phase (San Francisco Health Department, 2004).

In Africa, although the challenge of poor medication adherence has been discussed and debated for at least three decades, these problems have generally been overlooked as a serious public health issue and, as a result, have received little direct, systematic, or sustained intervention. As a consequence, Africans have inadequate knowledge about the significance of medication adherence as a critical element of their improved health. Further, adherence rates suffer from the fragmented approach by which hospitals, health care providers, and other parts of the health delivery system intervene with patients and caregivers to encourage adherence. Consequently, many leading medical societies are now advocating a multidisciplinary approach through coordinated action by health professionals, researchers, health planners and policymakers (McKinley, 1997).

Unfortunately, however, these calls for action have yet to be heeded and rates of medicine adherence have not improved. Thus, action is needed now to reduce the adverse health and economic consequences associated with this pervasive problem. While no single strategy will guarantee that patients will fill their prescriptions and take their medicines as prescribed, elevating adherence as a priority issue and promoting best practices, behaviours, and technologies may significantly improve medication adherence in the African medicines. For example, a common reason why patients don’t take their medicines is simply forgetfulness (Salomon, 1997).

Another significant barrier is the inability to understand and act on instructions for taking the medication. In fact, a study found that 0 percent or more of patients being followed could not correctly report what their physicians told them about medication use 0 to 80 minutes after receiving the information. While problems such as these are significant, public health officials are increasingly concerned about patients and especially those with chronic conditions requiring long-term therapy, such as asthma, diabetes, and hypertension, which make a conscious choice not to fill the prescription, not to take their medicine as prescribed, or to discontinue therapy. Influencing these decisions is a number of factors related to the patient’s experiences, perceptions, and understanding about his or her disease in this case, tuberculosis (Salihu, 2001).

Statement of the problem Although the challenge of poor medication adherence has been discussed

and debated for at least three decades, these problems have generally been overlooked as a serious public health issue and, as a result, have received little direct, systematic, or sustained intervention. However, these calls for action have yet to be heeded and rates of medicine adherence have not improved. Thus, action is needed now to reduce the adverse health and economic consequences associated with this pervasive problem.

It is against this background that the researcher found it necessary to investigate the impact of health education on TB drug adherence among TB patients at the Moi Teaching and Referral Hospital, Eldoret.

1.3 Objectives of the study Main objective To determine the impact of health education on TB drug adherence at Moi

teaching and referral hospital. Specific objective The study will be guided by the following specific objectives; To identify the level of adherence among TB patients at Moi teaching and

referral hospital. To assess the level of patient’s health education on TB drugs. To identify barriers of TB education. To investigate the challenges facing TB patients on treatment. To determine the level of training given to health workers on TB drug

adherence.

Research questions The study will aim at answering the following research questions; What is the level of adherence among TB patients’ at MTRH? What is the level of patents’ health education on TB drugs? What are the barriers of TB Education? What are some of the challenges facing TB patients on treatment? What is the level of training given to health workers on TB drug

adherence? Significance of the study The study will be of great importance to the Moi Teaching and Referral

Hospital due to the fact that the doctors and nurses there will come up with efficient ways of offering their patients’ health education on the need to adhere to their drug prescriptions for the sake of their health.

The study shall also be of great importance to the society as it will enlighten the people on the effects of TB and the importance of adhering to the drugs issued to them and the treatment so as to avoid a recap of the same.

The study will also indirectly benefit the country economically as it through health education to all citizens; the government shall save on costs that are incurred as a result of lack of adherence to treatment of TB.

Scope of the study The study will aim at investigating the impact of health education on Tuberculosis

drug adherence. It will take place between the months of July and August. The study will target 17 doctors, 119 nurses and 143 patients of Tuberculosis of MTRH.

Limitations of the study The study will be limited by a number of factors; firstly, consolidating the

respondents shall be a difficult task because the hospital is a busy hospital and it might be quite difficult to gather the respondents who will participate in the study.

Secondly, the respondents especially the patients might refrain from giving full and truthful responses to the researcher for fear of being victimized.

However, the researcher assured them that their responses shall be treated with utmost confidentiality.

     

CHAPTER TWOLITERATURE REVIEW

This chapter will focus on the literature review of the study and it will also discuss the specific objectives laid out in this study.

2.1 Concept of TB patient adherence Patient adherence to prescribed medicine has long been identified

as a problem by clinical, behavioural and social science researchers (Carder et al 2003). Non- adherence to treatment is considered one of the most serious problems in the control of tuberculosis since it may contribute to the spread of tuberculosis and the emergence of drug resistant strains of TB.

Failure to take tuberculosis medication as prescribed can easily result in ongoing or recurrent disease. Having a health care worker present to directly observe patients taking each dose of anti-TB medicine has been touted as the best way to ensure adherence to treatment, thereby diminishing the risk of trans mission, relapse/reactivation and drug resistance. However, even with this approach patient non-adherence to DOT still occurs. One problem cited is, that it is difficult to anticipate who will comply with treatment. It has been shown that demographic factors such as age, sex, ethnicity, education and socio- economic status are not accurate predictors of adherence (Weis et al 1994; Chaulk et al 1998).

On the other hand, psychiatric illness, substance abuse (alcohol and drug) and homelessness do typically predict non-adherence (Weis et al 1994; Davidson et al 2000). In general, however, the best predictor of non-adherence is a previous history of non-adherence (Pablos-Mendez et al 1997). Patients’ own belief systems and the constraints of their everyday life can also act as barriers to effective treatment. For example, in a Canadian study of socio-cultural factors influencing prevention and treatment of tuberculosis in immigrant and Aboriginal communities conducted by Gibson et al (2005), some participants thought that TB was caused by an irresponsible lifestyle, while others felt that they contracted TB because they had not taken proper care of themselves. Moreover, a number of participants in this study (primarily Aboriginal) believed that there was a stigma associated with having TB that influenced their attitude toward prevention and treatment (Gibson et al 2005).

CHAPTER THREEMETHODOLOGY

This section presents the research design, location of the study, target population, sample and sampling techniques, sample size, instrument of the study, piloting of study, data collection procedure, data analysis procedures and legal and ethical considerations.

Research design The study will employ a case study research design. The case study

was chosen since it allows for an investigation within a real life context. The case study will be carried out at the Moi Teaching and Referral Hospital.

Study Area The study area shall be the Moi Teaching and Referral Hospital

which is situated in Eldoret town, Uasin Gishu County. The researcher chose this study area as the hospital is the second largest hospital in the country and it has quite a number of patients suffering from tuberculosis.

Target Population The target population will comprise of 17 doctors, 119 nurses and

320 patients suffering from tuberculosis.6Target population Frequency

Doctors 17

Nurses 119

Patients 320

TOTAL 456

Sample and sampling techniques The study will employ simple random sampling to select the

respondents who will participate in the study. Simple random sampling was chosen since it is not biased.Target population Frequency procedure Sample size

Doctors 17 100% * 17 17

Nurses 119 30% * 119 36

Patients 320 30% * 320 96

TOTAL 456 149

Research instruments The researcher will employ the use of both primary and secondary sources of

data. Questionnaires and interview schedule will be used to collect the primary data while documented data (TB facility registers) will be sources of secondary data.

Inclusion Criteria All patients who have finished intensive phase of TB treatment All patients who have completed continuation phase. Exclusion criteria All patients not on TB treatment Newly diagnosed patients Questionnaires The researcher will prepare and administer questionnaires to the TB

patients, nurses and doctors. Questionnaires offers considerable advantages as it presents an even

stimulus to a large number of people simultaneously and provide investigator with a relatively easy accumulation of data, further the use of questionnaires allows the respondents time on questions that would require reflections on to avoid nasty responses, however they require a lot of time in traveling hence a lot of expenses that inflate research cost, and some respondents do not answer all the questions.

Data analysis proceduresThe data from the questionnaire will be coded as the first

step of data analysis. The information obtained will summarized and presented using frequency tables, pie charts and histograms.

Editing will be done to detect errors and omissions thus ensuring that the data are accurate, consistent with other facts gathered, uniformly entered, as complete as possible and arranged to facilitate and improve the quality of the data for coding and tabulation by reading through and correcting any topographical errors resulting from respondents not having been too careful when responding.

The study will adopt both the qualitative and quantitative analysis in order to achieve the objective of the study.

Ethical considerations The researcher shall seek permission from the director and

head of departments of the hospital so as to ensure that she follows the right procedure while collecting data from the respondents who will participate in the study.

To ensure informed consent, the researcher will explain the purpose of the evaluation prior to beginning the answering of questions. In all cases, interviewees will be assured that the responses are confidential and that no personal information about the respondents will be conveyed in the report.

WORK PLANACTIVITY March2013 April 2013 May 2013 June 2013 July 2013 August 2013

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