Table 4. Interventions considered to strengthen the psychosocial support for MDR-TB patients in Nepal, (2014).
| Interventions (Michie et al 2011) | Intervention targeted at health workers and the health system | Intervention targeted at patients/family members | Purpose, determinant and COM-B addressed |
|---|---|---|---|
| Education: increasing knowledge and understanding. | Developing understanding of different patient needs based on gender and living conditions through training. Continual professional development and guidelines for health workers on treatment, side-effects. | Leaflets, posters and session with health worker using flip book of key messages on side-effects, treatment process and infection control. Talks by health workers during peer support sessions. | To increase knowledge on treatment and side-effects. Capability: psychological. Motivation: reflective. |
| Persuasion: using communication to induce positive or negative feelings or stimulate action. | Role play during training of supportive relationship with patients. Posters presenting a positive image of compassionate health workers. | Inclusion of ‘expert patients’ successfully treated for MDR-TB to tell their stories during support groups and in leaflets. Use of buddying system to provide support to both patients and family members. | To improve communication with health workers and build hope. Motivation: reflective and automatic. |
| Training: imparting skills. | Training on communication skills and psychological counselling for health workers. | Health worker -led consultation with patients and carers using flip book to impart skills for dealing with treatment, side-effects, infection control, nutrition and basic care. Leaflets detailing the severity of side-effects, clarifying which require immediate clinical advice and which are less urgent and do not require treatment change. Access to a phone help-line to provide timely advice to patients and carers. | To build skills of carers, patients and health workers. Capabilities: physical and psychological. |
| Environmental restructuring: changing the physical or social context. | Restructure clinics to allow privacy for patients to receive treatment and counselling. Establishing phone help lines increasing HW opportunities to engage with patients within busy workload. Encouraging family members to attend appointments with patients throughout treatment. | Peer support groups for patients, and separately for family members to share problems and solutions. Ensuring that peer groups and buddying networks are geographically close and appropriate to the patient. | To increase social support, particularly targeting those most in need. Motivation: automatic Opportunities: physical and social |
| Modelling: providing an inspirational example. | Awards for most supportive staff and DOTS Plus centres with case studies of their approach. | Expert patients (men and women) providing example of living through MDR-TB. Posters showing supportive family, particularly with married women as patients. | To build hope among patients and family member carers. Motivation: automatic. |
| Enablement: increasing means/reducing barriers. | Bringing care closer to patients, decentralised treatment centres. Use of disaggregated data to understand outcomes for different patient groups. Providing staff with the time/facilities/resources for patient support strategies and supportive monitoring and supervision. Routine inclusion of assessments of social support, depression and anxiety during initial consultations and throughout treatment. | Review of financial support amount and timely distribution. Review of hostel provision, with special consideration of women patients. Employment and livelihood opportunities to promote social inclusion, reduce stigma, and enhance access to services through economic support. | To provide a health system that enables targeted psycho-social support and reduces patient hardship. Capabilities: physical and psychological. Motivation: automatic Opportunities: physical and social. |
*Text in bold indicates intervention strategies to be tried in the subsequent feasibility study. Non-highlighted text indicates areas of policy change for consideration by NTP.