1
|
Hovell MF, Schmitz KE, Blumberg EJ, Hill L, Sipan C, Friedman L. Lessons learned from two interventions designed to increase adherence to LTBI treatment in Latino youth. Contemp Clin Trials Commun 2018; 12:129-136. [PMID: 30456327 PMCID: PMC6234503 DOI: 10.1016/j.conctc.2018.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 08/02/2018] [Accepted: 08/13/2018] [Indexed: 10/29/2022] Open
Abstract
Effort is required to meet the Healthy People 2020 goal of tuberculosis (TB) disease reduction to 1 new case per 100,000 in the United States (US) and reduce burden among those disparately affected. Preventing new cases by reducing conversion from latent TB infection (LTBI) to infectious disease is one approach to reducing disease burden. This paper describes the outcome of a trial designed to determine if LTBI-positive youth prescribed daily Isoniazid with peer counseling would achieve higher adherence than attention control participants. The paper also compares adherence to a previous trial. 263 students age 15.9 years (SD = 1.2), 51.7% female, 96.2% Latino, 43.7% foreign-born were randomly assigned to condition. Adherence was measured by self-report validated by metabolite analysis. Outcome analyses used number of pills taken and proportion of youth consuming 80% of medication. There was no significant difference by condition for either analysis. Thirty-seven percent of adherence participants completed treatment versus 40% of controls. Without a usual-care control group we were unable to determine whether conditions were equally effective or ineffective. The study's inability to pay for treatment resulted in the intervention being tested in the context of compromised access to care. Still to be determined is whether same-age peers can influence adherence among Latino adolescents. TRIAL REGISTRATION ClinicalTrials.gov Identifier NCT00233168.
Collapse
Affiliation(s)
- Melbourne F. Hovell
- The Center for Behavioral Epidemiology and Community Health, Graduate School of Public Heath, San Diego State University, San Diego, CA, United States
| | - Katharine E. Schmitz
- The Center for Behavioral Epidemiology and Community Health, Graduate School of Public Heath, San Diego State University, San Diego, CA, United States
| | - Elaine J. Blumberg
- The Center for Behavioral Epidemiology and Community Health, Graduate School of Public Heath, San Diego State University, San Diego, CA, United States
| | - Linda Hill
- Department of Family and Preventive Medicine, University of California, San Diego, CA, United States
| | - Carol Sipan
- The Center for Behavioral Epidemiology and Community Health, Graduate School of Public Heath, San Diego State University, San Diego, CA, United States
| | - Lawrence Friedman
- School of Medicine, University of California, San Diego, CA, United States
| |
Collapse
|
2
|
Hossain S, Zaman K, Quaiyum A, Banu S, Husain A, Islam A, Borgdorff M, van Leth F. Factors associated with poor knowledge among adults on tuberculosis in Bangladesh: results from a nationwide survey. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2015; 34:2. [PMID: 26825614 PMCID: PMC5465564 DOI: 10.1186/s41043-015-0002-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Accepted: 01/08/2015] [Indexed: 06/05/2023]
Abstract
INTRODUCTION In 2012, Bangladesh continues to be one of the 22 high tuberculosis (TB) burden countries in the world. Although free diagnosis and management for TB is available throughout the country, case notification rate/100,000 population for new smear positive (NSP) cases under the national TB control programme (NTP) remained at around 70/100,000 population and have not changed much since 2006. Knowledge on TB disease, treatment and its management could be an important predictor for utilization of TB services and influence case detection under the NTP. Our objective is to describe knowledge of TB among newly diagnosed TB cases and community controls to assess factors associated with poor knowledge in order to identify programmatic implications for control measures. METHODS Embedded in TB prevalence survey 2007-2009, we included 240 TB cases from the TB registers and 240 persons ≥ 15 years of age randomly selected from the households where the survey was implemented. All participants were interviewed using a structured, pre-tested questionnaire to evaluate their TB knowledge. Regression analyses were done to assess associations with poor knowledge of TB. RESULTS Our survey documented that overall there was fair knowledge in all domains investigated. However, based on the number of correct answers to the questionnaires, community controls showed significantly poorer knowledge than the TB cases in the domains of TB transmission (80% vs. 88%), mode of transmission (67% vs. 82%), knowing ≥ 1 suggestive symptoms including cough (78% vs. 89%), curability of TB (90% vs. 98%) and availability of free treatment (75% vs. 95%). Community controls were more likely to have poor knowledge of TB issues compared to the TB cases even after controlling for other factors such as education and occupation in a multivariate model (OR 3.46, 95% CI: 2.00-6.09). CONCLUSIONS Knowledge on various aspects of TB and TB services varies significantly between TB cases and community controls in Bangladesh. The overall higher levels of knowledge in TB cases could identify them as peer educators in ongoing communication approaches to improve care seeking behavior of the TB suspects in the community and hence case detection.
Collapse
Affiliation(s)
- Shahed Hossain
- Centre for Equity and Health Systems (CEHS), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka, 1212 Bangladesh
| | - Khalequ Zaman
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka, 1212 Bangladesh
| | - Abdul Quaiyum
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka, 1212 Bangladesh
| | - Sayera Banu
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka, 1212 Bangladesh
| | - Ashaque Husain
- National TB Control Programme (NTP), DGHS, Dhaka, Bangladesh
| | | | - Martien Borgdorff
- Department of Clinical Epidemiology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
- Centre for Infection and Immunity Amsterdam, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
- Public Health Service, Amsterdam, The Netherlands
| | - Frank van Leth
- Department of Global health, Academic Medical Centre, Amsterdam Institute for Global Health and Development, University of Amsterdam, Amsterdam, The Netherlands
- KNCV Tuberculosis Foundation, The Hague, The Netherlands
| |
Collapse
|
3
|
O’Mara-Eves A, Brunton G, McDaid D, Oliver S, Kavanagh J, Jamal F, Matosevic T, Harden A, Thomas J. Community engagement to reduce inequalities in health: a systematic review, meta-analysis and economic analysis. PUBLIC HEALTH RESEARCH 2013. [DOI: 10.3310/phr01040] [Citation(s) in RCA: 156] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundCommunity engagement has been advanced as a promising way of improving health and reducing health inequalities; however, the approach is not yet supported by a strong evidence base.ObjectivesTo undertake a multimethod systematic review which builds on the evidence that underpins the current UK guidance on community engagement; to identify theoretical models underpinning community engagement; to explore mechanisms and contexts through which communities are engaged; to identify community engagement approaches that are effective in reducing health inequalities, under what circumstances and for whom; and to determine the processes and costs associated with their implementation.Data sourcesDatabases including the Cochrane Database of Systematic Reviews (CDSR), The Campbell Library, the Database of Abstracts of Reviews of Effects (DARE), the Health Technology Assessment (HTA) database, the NHS Economic Evaluation Database (NHS EED) and EPPI-Centre’s Trials Register of Promoting Health Interventions (TRoPHI) and Database of Promoting Health Effectiveness Reviews (DoPHER) were searched from 1990 to August 2011 for systematic reviews and primary studies. Trials evaluating community engagement interventions reporting health outcomes were included.Review methodsStudy eligibility criteria: published after 1990; outcome, economic, or process evaluation; intervention relevant to community engagement; written in English; measured and reported health or community outcomes, or presents cost, resource, or implementation data characterises study populations or reports differential impacts in terms of social determinants of health; conducted in an Organisation for Economic Co-operation and Development (OECD) country. Study appraisal: risk of bias for outcome evaluations; assessment of validity and relevance for process evaluations; comparison against an economic evaluation checklist for economic evaluations. Synthesis methods: four synthesis approaches were adopted for the different evidence types: theoretical, quantitative, process, and economic evidence.ResultsThe theoretical synthesis identified key models of community engagement that are underpinned by different theories of changes. Results from 131 studies included in a meta-analysis indicate that there is solid evidence that community engagement interventions have a positive impact on health behaviours, health consequences, self-efficacy and perceived social support outcomes, across various conditions. There is insufficient evidence – particularly for long-term outcomes and indirect beneficiaries – to determine whether one particular model of community engagement is likely to be more effective than any other. There are also insufficient data to test the effects on health inequalities, although there is some evidence to suggest that interventions that improve social inequalities (as measured by social support) also improve health behaviours. There is weak evidence from the effectiveness and process evaluations that certain implementation factors may affect intervention success. From the economic analysis, there is weak but inconsistent evidence that community engagement interventions are cost-effective. By combining findings across the syntheses, we produced a new conceptual framework.LimitationsDifferences in the populations, intervention approaches and health outcomes made it difficult to pinpoint specific strategies for intervention effectiveness. The syntheses of process and economic evidence were limited by the small (generally not rigorous) evidence base.ConclusionsCommunity engagement interventions are effective across a wide range of contexts and using a variety of mechanisms. Public health initiatives should incorporate community engagement into intervention design. Evaluations should place greater emphasis on long-term outcomes, outcomes for indirect beneficiaries, process evaluation, and reporting costs and resources data. The theories of change identified and the newly developed conceptual framework are useful tools for researchers and practitioners. We identified trends in the evidence that could provide useful directions for future intervention design and evaluation.FundingThe National Institute for Health Research Public Health Research programme.
Collapse
Affiliation(s)
- A O’Mara-Eves
- Evidence for Policy and Practice Information and Co-ordinating Centre (EPPI-Centre), Social Science Research Unit, Institute of Education, London, UK
| | - G Brunton
- Evidence for Policy and Practice Information and Co-ordinating Centre (EPPI-Centre), Social Science Research Unit, Institute of Education, London, UK
| | - D McDaid
- Personal Social Services Research Unit and European Observatory on Health Systems and Policies, London School of Economics and Political Science, London, UK
| | - S Oliver
- Evidence for Policy and Practice Information and Co-ordinating Centre (EPPI-Centre), Social Science Research Unit, Institute of Education, London, UK
| | - J Kavanagh
- Evidence for Policy and Practice Information and Co-ordinating Centre (EPPI-Centre), Social Science Research Unit, Institute of Education, London, UK
| | - F Jamal
- Institute for Health and Human Development, University of East London, London, UK
| | - T Matosevic
- Personal Social Services Research Unit, London School of Economics and Political Science, London, UK
| | - A Harden
- Institute for Health and Human Development, University of East London, London, UK
- Barts Health NHS Trust, London, UK
| | - J Thomas
- Evidence for Policy and Practice Information and Co-ordinating Centre (EPPI-Centre), Social Science Research Unit, Institute of Education, London, UK
| |
Collapse
|
4
|
Liu Q, Liu L, Vu H, Liu X, Tang S, Wang H. Comparison between peer-led and teacher-led education in tuberculosis prevention in rural middle schools in Chongqing, China. Asia Pac J Public Health 2013; 27:NP2101-11. [PMID: 24097927 DOI: 10.1177/1010539513498767] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The aim of this study was to investigate the efficacy of tuberculosis (TB) education through a comparison of peer-led and teacher-led methods of education about TB prevention among middle school students in rural Chongqing, China. A preintervention and postintervention questionnaire survey was conducted in 2 different middle school student groups to measure changes in knowledge, attitude, and practice (KAP) status of those students before and after each TB education program. Of 1265 students participating in the preintervention survey, 1176 completed the postintervention survey. KAP scores of both peer-led and teacher-led groups after intervention improved by as much as 2 times compared with before the intervention and those of the control group (P < .01). KAP scores of immediate evaluation were higher than those of long-term evaluation in the teacher-led education group (P < .01). The teacher-led group had a larger improvement than the peer-led group in practice scores (P < .01) in immediate effect evaluation.
Collapse
Affiliation(s)
- Qin Liu
- Chongqing Medical University, Chongqing, China
| | - Liping Liu
- The First Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Huyen Vu
- Duke University, Durham, NC, USA
| | - Xiaoxue Liu
- Chongqing Medical University, Chongqing, China
| | | | - Hong Wang
- Chongqing Medical University, Chongqing, China
| |
Collapse
|
5
|
Hovell MF, Sipan CL, Blumberg EJ, Hofstetter CR, Slymen D, Friedman L, Moser K, Kelley NJ, Vera AY. Increasing Latino adolescents' adherence to treatment for latent tuberculosis infection: a controlled trial. Am J Public Health 2003; 93:1871-7. [PMID: 14600055 PMCID: PMC1448065 DOI: 10.2105/ajph.93.11.1871] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2002] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We sought to determine the efficacy of coaching Latino adolescents with latent tuberculosis infection to adhere to isoniazid treatment. METHODS Participants (n = 286) were randomly assigned to adherence coaching, attention control, or usual care groups. Adherence was measured via interviews and validated with urine assays. RESULTS Coaching resulted in significant increases in adherence compared with attention and usual care groups. Bicultural adolescents were more likely to be adherent than those most or least acculturated. Age and risk behavior were negatively related to adherence. CONCLUSIONS Coaching can increase Latino adolescents' adherence to treatment for latent tuberculosis infection and should contribute to tuberculosis control for adolescents at high risk of contracting the disease.
Collapse
Affiliation(s)
- Melbourne F Hovell
- Center for Behavioral Epidemiology and Community Health, Graduate School of Public Health, San Diego State University, CA 92123, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
6
|
Hovell M, Blumberg E, Gil-Trejo L, Vera A, Kelley N, Sipan C, Hofstetter CR, Marshall S, Berg J, Friedman L, Catanzaro A, Moser K. Predictors of adherence to treatment for latent tuberculosis infection in high-risk Latino adolescents: a behavioral epidemiological analysis. Soc Sci Med 2003; 56:1789-96. [PMID: 12639595 DOI: 10.1016/s0277-9536(02)00176-4] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The objective was to test whether theoretical variables predict adherence to treatment for latent tuberculosis infection in high-risk Latino adolescents. 286 Latino adolescents, age 13-18 years, were recruited from 10 middle/high schools in San Diego County, San Diego, USA. Participants completed a baseline interview and up to 9 monthly interviews. The cumulative number of pills consumed in 9 months was regressed on 16 independent variables, entered hierarchically in seven blocks. The final model accounted for 25% of the variance in adherence to isoniazid (INH), F (16, 230)=4.69, p<0.001. Adherence counseling (+), age (-), grades (+), being bicultural (+), and risk behaviors (-) were significantly related to adherence. Learning theories presume that adherence to medical regimens requires social support and freedom from physical and social barriers. Results support these theories. Future studies should explore additional precepts in order to identify additional predictors and to maximize adherence to INH among Latino adolescents and other high-risk populations. Doing so should decrease the risk of active TB among high-risk racial/ethnic and foreign-born populations.
Collapse
Affiliation(s)
- Melbourne Hovell
- Center for Behavioral Epidemiology, Graduate School of Public Health, San Diego State University, 9245 Sky Park Court, Ste 230, 92123, CA, USA.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
7
|
Morisky DE, Malotte CK, Ebin V, Davidson P, Cabrera D, Trout PT, Coly A. Behavioral interventions for the control of tuberculosis among adolescents. Public Health Rep 2002. [PMID: 12196616 DOI: 10.1016/s0033-3549(04)50089-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVES Activation of latent tuberculosis infection into tuberculosis disease (TB), the primary killer among infectious diseases worldwide, can be prevented with six months of anti-TB medication. A large percentage of adolescents started on medication, however, fail to complete their treatment. The authors developed and tested the effects of innovative educational strategies on infected adolescents at two health centers serving ethnically diverse populations. METHODS The authors used a randomized experimental four-group design to assess the independent and combined effects of peer counseling and a participant-parent contingency contract intervention. RESULTS A total of 794 adolescents were recruited into the study, for a 79% participation rate. The overall rate of treatment completion was 79.8%. Self-efficacy for medication-taking behavior at post-test correlated strongly with completion of care (R = 0.367, p = 0.002). Participants randomized to the peer counseling groups demonstrated significantly greater improvements in self-efficacy and mastery than the usual care control group. Based on the study results, continuing education seminars and workshops were implemented for TB control staff at the two health clinics and for all TB Control Division staff at the Los Angeles County Health Department. Educational materials and a training manual for enhancing completion of treatment of latent TB infection through tailored educational approaches were developed and disseminated to the clinics. CONCLUSIONS Health education and incentives are helpful adjuncts to the completion of treatment for latent tuberculosis infection in adolescents.
Collapse
Affiliation(s)
- D E Morisky
- Dept. of Community Health Services, School of Public Health, University of California Los Angeles, Box 951772, Los Angeles, CA 90095, USA.
| | | | | | | | | | | | | |
Collapse
|
8
|
Posavac EJ, Kattapong KR, Dew DE. Peer-based interventions to influence health-related behaviors and attitudes: a meta-analysis. Psychol Rep 1999; 85:1179-94. [PMID: 10710973 DOI: 10.2466/pr0.1999.85.3f.1179] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The effects of 47 peer-based health education programs described in 36 published studies were examined. The over-all effect size was small: the mean d was .190 when controls received no program and .020 when controls received an alternative program. Programs were divided into those focusing on preventing or reducing smoking and programs on other health issues; the latter were further divided into primary prevention and secondary prevention programs. Differences among studies suggested several biases which were likely to have influenced the effect sizes. Preventive interventions that produce only small effects can be valuable because many participants would not have developed the problem even without the program. This review suggested that, when health education programs are studied, (a) detailed statistical information should be provided to facilitate using the research findings in meta-analyses and (b) the costs of innovative programs should be presented to judge whether the results are worth the cost.
Collapse
Affiliation(s)
- E J Posavac
- Department of Psychology, Loyola University of Chicago, IL 60626, USA.
| | | | | |
Collapse
|