Geneva Health Forum Archive

Browse and download abstracts, posters, documents and videos from past editions of the GHF

Knowledge and Access to Health by Tuberculosis Patients in India.

Author(s) Hemmavathy M.T.Valluvan1, Karuna Sagili2, Srinath S3, Sarabjit S Chadha 4, Nevin C Wilson 5.
Affiliation(s) 1 Medical School, Monash University, Melbourne, Australia, The Union South-East Asia Office, International Union Against Tuberculosis and Lung Disease (The Union), Delhi, India, The Union South-East Asia Office, International Union Against Tuberculosis and Lung Disease (The Union), Delhi, India, The Union South-East Asia Office, International Union Against Tuberculosis and Lung Disease (The Union), Delhi, India, The Union South-East Asia Office, International Union Against Tuberculosis and Lung Disease (The Union), Delhi, India.
Country - ies of focus India
Relevant to the conference tracks Advocacy and Communication
Summary India is one among the 22 highest TB burden countries contributing a large proportion of the global TB cases. To increase awareness on the issue of TB, India’s RNTCP uses several forms of media to communicate TB related information to the general population. As part of Project Akshya, a baseline Knowledge, Attitude and Practices (KAP) study was conducted in 30 districts of India to gather baseline information from specific target groups on TB. The following study analyses the KAP and describes the media behaviour of TB affected individuals in India, with a focus on their key sources of general health related and TB related information, and identifies the most trusted source of information.
Background Infectious diseases are one of the key contributors to the mortality of people around the world. Globally, of the 57 million deaths that occurred in 2011, 21 million deaths were caused by infectious diseases (WHO, 2012b). Of the infectious diseases Tuberculosis (TB) persists to be one of the leading causes of mortality since the 1800s (Houston, 1999). An estimated 8.7 million new cases of TB occurred in 2011 globally and a total of 1.4 million people died from TB (WHO, 2012a). India is the highest TB burden country accounting for 26% of global cases (WHO, 2012a).
India’s National Tuberculosis Programme-RNTCP (Revised National Tuberculosis Control Programme) uses several forms of media to communicate TB related information to the general population and TB affected individuals. These range from street plays to radio commercials (Mehrotra, 1998). A similar study was done in Chandigarh (Hemlata, 2011). The other studies that were conducted in Delhi targeted specific populations such as homemakers (R.Malhotra, 2002), and the rural population (Sharma and Sharma, 2007). However these studies  are localised and focused upon limited target groups within the general population.
Objectives In 2010, Project Axshya ACSM (Advocacy, Communication and Social Mobilisation) project was initiated in India as part of the Global Funded Round 9 India TB programme. It is being implemented in 374 districts across 23 states covering a population of approximately 75 million people. The main objective of Project Axshya is to empower the community and each individual through education/awareness on TB with various resources and knowledge that would enable India to reach the ultimate goal of reducing the mortality and morbidity caused by TB. The baseline KAP (Knowledge, Attitude and Practices) study was conducted in 30 districts of India as part of Project Axshya, which aimed to gather baseline information from specific target groups (the general population, TB patients, health service providers, NGO’s and opinion leaders) on their knowledge, attitude and practices on TB. The survey tool designed for TB patients had specific questions on their sources of information about general health and TB. By comparing the different characteristics of the TB patients and the media source through which they gained the information, we would locate the media forms currently being accessed by TB affected individuals. This will also inform future planning of the health information dissemination programs.
In this study we aim to describe the types of mass media used by TB patients to gain information on general health related, TB and DOTS and to describe the most preferred and trusted sources of mass media from the patient’s perspective and then relate it to various patient characteristics.
Methodology Study Design.
A cross sectional community based survey was conducted in 30 districts out of the 374 districts under Project Axshya. These districts were selected using stratified cluster sampling method. These districts were further divided into primary sampling (PSUs). Depending on the number of households, in each PSU a minimum of 250 households were line listed with an estimated population of 1000. 10 PSUs were randomly selected from each district. Trained field investigators from the social research organisation GfK MODE visited these selected PSU’s and conducted the survey during the months of January - March 2011 using pretested semi-structured questionnaires.
To address the study objectives, the data collected from ‘Media and Information Sources’ section of the questionnaire for TB patients in KAP has been used for analysis.Data Entry and Analysis.
The data collected was recorded in a pre-structured data-entry form in Fox Pro (version 2.6). The data was analysed and tables generated using Epidata Analysis software.

Ethical Considerations.
Baseline KAP study was approved by the Ethics Advisory Group of the International Union Against Tuberculosis and Lung Disease. Permission to conduct this study was given by the Central TB Division, Ministry of Health and Family Welfare, Government of India. Informed consent was obtained from each respondent and, where possible, written consent was obtained. Confidentiality of the data was assured.

Results The general profile of TB affected individuals interviewed in this survey in relation to their access to services informs that 67% of them have access to electricity, 14% have a radio set at their houses, 36% have television sets at their homes and 52% have mobile phones. 56% of the total TB affected individuals interviewed had BPL (Below Poverty Line) identity cards. The source of information for 65% of TB patients on any health related information was via interpersonal communication (Table 1). Likewise, interpersonal communication was the leading source of information for TB (74%)(Table 1). With regards to information on DOTS, 61% of the TB patients did not receive any information on DOTS (Table 1). 56% of those who are exposed to interpersonal communication as their source of information received information on TB from that source (Table 2). Among these 56% there was a significant difference among the low and high income households (p=0.0000), rural and urban setting (p=0.0000), among the zones such as North (p=0.0000,OR:2.87,CI:1.89-4.35), South (p=0.0000,OR:0.25,CI: 0.16-0.39), East (p=0.0000,OR:3.07,CI:2.17-4.33) and West (p=0.0000,OR:0.16,CI:0.10-0.26). Of the 220 who had a television (TV) 67% indicated TV as their source of information for general health, 60% for TB related information and 41% for information on DOTS. Of the 85 people who had a radio set at their homes, 33% indicated radio as their source of information for general health, 35% for TB related information and 14% for DOTS related information. There was also a significant difference for those who used TV as their source of information for TB between the low and high income households (p=0.000), between the rural and urban settings (p=0.000), among the zones such as North (p=0.0006), South (p=0.0000) and East (p=0.0001) and education levels (p=0.0000). 43% of TB patients chose government health staff as their choice of trusted information source, followed by 15% of the TB patients trusting the private health workers. Among the 43% of TB patients who trust government health staff, there was a significant difference among the age of 25-34 years old (p=0.0288, OR:0.61, CI:0.39-0.95) and 35-44years old (p=0.0069,OR:1.70,CI:1.15-2.50), and students (p= 0.0049,OR:0.40,CI:0.21-0.77) and lastly, among the zones such as North (p=0.00573,OR:1.44,CI: 0.99-2.09), East (p=0.0000,OR:0.48,CI:0.34-0.67) and West (p=0.0000,OR:2.62,CI:1.69-4.06) had significant differences.
Conclusion From the KAP survey of TB patients, it was observed that 74% of TB patients received their TB related information from interpersonal communication which could partly be attributed to the people they had come into contact with in order to be diagnosed with TB. However, a separate analysis on where TB patients had received health related information found that 65% responded as the source being interpersonal communication followed by 34% receiving it from television. As such, interpersonal communication is an important medium through which a large portion of the TB patients received information. On further analysis, it was found that 56% of those exposed to interpersonal communications as their source of information received information on TB from that source. Household income played a significant role as possessing a television as the source of media for TB information. 20% of those with less than Rs.4000 received their TB information from TV while 46% of those with more than Rs.4000 did so. This could be due to the higher income group having the ability to afford a television, the added increase in electricity bill and a house that accommodates it. The geographical zones of the TB patients also played a role on their source of TB information. The key source of TB information for the North was word of mouth (74%), while that of South and West was Television (53% and 29% respectively). This is an important finding as it shows that different zones have different media behaviour which could be due its varied cultural behaviours or social structure. Hence when planning IEC activities, these factors should be considered in order to utilise the most accessed resources of the target population.There are three key findings from this analysis; different income groups/settings have different sources of media exposure, the choice of media exposure differs among the different zones and the population's trusted source of information. It is important to understand that the fundamental expectation of any media aspect of a health policy is to increase awareness on a health issue and due to increased knowledge, eventually see a decrease in the overall incidence in the condition. However, before waiting at the finishing line for this result, it is crucial to make sure that the information reaches the population effectively and efficiently. Further developments to this study would include a qualitative study to assess the knowledge level of TB patients and its relation to media exposure.

Leave a Reply