Abstract
BackgroundHealth promotion for prevention and control of Tuberculosis (TB) is implemented worldwide because of its importance, but few reports have evaluated its impact on behavior due to a lack of standard outcome indicators. The objective of this study was to establish a framework of behavioral indicators for outcome evaluation of TB health promotion among TB suspects and patients.MethodsA two-round modified Delphi method involving sixteen TB control experts was used to establish a framework of behavioral indicators for outcome evaluation of TB health promotion targeted at TB suspects and patients.ResultsSixteen of seventeen invited experts in TB control (authority score of 0.91 on a 1.0 scale) participated in round 1 survey. All sixteen experts also participated in a second round survey. After two rounds of surveys and several iterations among the experts, there was consensus on a framework of indicators for measuring outcomes of TB health promotion for TB suspects and patients. For TB suspects, the experts reached consensus on 2 domains (“Healthcare seeking behavior” and “Transmission prevention”), 3 subdomains (“Seeking care after onset of TB symptoms”, “Pathways of seeking care” and “Interpersonal contact etiquette”), and 8 indicators (including among others, “Length of patient delay”). For TB patients, consensus was reached on 3 domains (“Adherence to treatment”, “Healthy lifestyle” and “Transmission prevention”), 8 subdomains (including among others, “Adherence to their medication”), and 14 indicators (including “Percentage of patients who adhered to their medication”). Operational definitions and data sources were provided for each indicator.ConclusionsThe findings of this study provide the basis for debate among international experts on a framework for achieving global consensus on outcome indicators for TB health promotion interventions targeted at TB patients and suspects. Such consensus will help to increase effectiveness of TB health promotion, while ensuring international comparability of outcome data.
Highlights
Health promotion for prevention and control of Tuberculosis (TB) is implemented worldwide because of its importance, but few reports have evaluated its impact on behavior due to a lack of standard outcome indicators
The median for feasibility rankings of 6 items and mode for feasibility rankings of 5 items were 5; Coefficient of variation (CV) for feasibility rankings of 12 items were more than 0.3 (Table 3). These results indicated that expert rankings had good central tendencies for most items in terms of importance, but not for the feasibility
As for indicators for TB patients, experts in the firstround survey suggested the deletion of: 4 subdomains (“Change unhealthy lifestyle”, “Wearing respirator in intensive phrase in public”, “Behaviors related to deal with dishes”, and “Isolation room”), and 2 indicators (“Percentage of patients who used dishes and chopsticks separately” and “Percentage of patients who had separate living room from others in household”)
Summary
Health promotion for prevention and control of Tuberculosis (TB) is implemented worldwide because of its importance, but few reports have evaluated its impact on behavior due to a lack of standard outcome indicators. Given the public health significance of TB, health promotion interventions to prevent and control the disease have been conducted, and continue to be conducted globally In some cases, these interventions are aimed at strengthening people’s understanding of the disease and how to respond to symptoms [20,21,22,23,24]. Some countries, including China [27,28] and New Zealand [16], have issued special guidelines for TB health promotion that specify TB health promotion activities targeting behavioral interventions for different populations groups [17] These guidelines lack appropriate indicators for assessment of outcomes. Knowledge alone often does not translate to actual behavior changes [29,30,31]
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