1. Module 7: Patient Education

2. Learning Objectives Explain the importance of patient education during the TB treatment process Describe the District TB coordinators role for encouraging effective patient education at health facilities Learn to identify signs of inadequate pt. education Identify effective communication skills useful for health education List TB topics that health care workers should inform patients about throughout treatment

3. Introduction to Patient Education Critical part of treating TB All HCWs who diagnosis, register, and/or treat TB patients should know about effective communication HCWs must communicate with patient clearly and supportively throughout –diagnosis –long treatment process Information and support should also be given to patients family

4. Teaching patients and families about TB and its treatment helps patients –understand the problem –better adhere to treatment Critical for encouraging patients to return for the next treatment visit One of the main reasons for patient default is the attitude of the health worker Importance of Patient Education and Good Communication Skills

5. District TB Coordinators Role in Patient Education and Resources

6. Trainings Emphasize importance of educating the patient Emphasize support role of family –adherence –Side effects –Communicating with HCWs –Family should NOT do DOT Explain effective communication skills

7. During Supervisory Visits Assess HCWs communication skills by –observing patient interaction –talking to patient to determine if they understand treatment process Review facility treatment indicators –high default rates may indicate a need for more effective patient education Determine if health facilities are in need of patient education materials Image Source: World Lung Foundation

8. Effective Communication Skills

9. Ask questions and listen (use open-ended questions) Make interaction with the patient a positive experience Speak clearly and simply Encourage patient to ask questions Ask checking questions to determine understanding Effective communication skills for HCWs

10. Ask Questions and Listen To understand the patients medical history To understand the patients current knowledge about TB Identify and help to solve any problems the patient may have with treatment Use open-ended questions

11. Cannot be answered with yes or no Usually start with: –What? –Why? –Who? –When? –How? –Explain or describe to me….. Ask Questions and Listen: Open-Ended Questions

12. Close-Ended vs. Open-Ended Do you know anything about TB? –What do you know about TB? Do you live alone? –Who else do you live with?

13. Demonstrate a caring, respectful attitude –actions –words –body language –tone of voice –eye contact Praise and encourage patient Motivate the patient to continue treatment Be non-judgmental if patients views or lifestyles differ from your own Make Interaction with the Patients a Positive Experience

14. Speak Clearly and Simply (1) Use simple non-medical terms Use words that are familiar to the patient Use appropriate language level and visual cues Repeat important information Image source: WHO

15. Speak Clearly and Simply (2) Example: Diffcult to understand This drug, isoniazid is a bactericidal agent that is highly active against Mycobacterium tuberculosis Simple to understand This isoniazid pill will help fight TB and help you get better

16. Encourage Patient to Ask Questions Ask patients Do you have any questions Praise patients for asking questions –I am glad that you asked that question… –Good question… Answer all questions thoughtfully and carefully

17. Ask Checking Questions Ask patient questions –to understand the patients current knowledge about TB –to ensure that the patient knows exactly what to do next Examples When will you cough up sputum? What container will you use?

18. Topics to Discuss

19. Patient Education Throughout Treatment Patient education is a continuous process throughout treatment Important to emphasize different health education messages at different times during treatment At each encounter with the patient, the HCW can choose some appropriate messages to teach or reinforce

20. First Patient Visit Topics for Discussion What is TB How TB spreads and how to prevent it –Importance of examining contacts Symptoms of TB TB can be cured– even among HIV+ patients Treatment of TB –duration; where to receive; importance of adherence and completion

21. First Patient Visit Directly Observed Therapy What to expect; what to do next –the need to minimize travel (i.e. to cattle posts) until after completion of treatment Emphasize importance of knowing HIV status Reinforcement of HIV prevention messages

22. Additional Topics to Discuss Throughout Treatment Description of treatment drugs (show pills) –amount and frequency of drugs –possible side-effects of drugs Treatment during continuation phase Importance of adherence Importance of good nutrition and abstaining from smoking and alcohol Frequency and importance of sputum collection Image source: Gary Hampton, World Lung Foundation Image source: Pierre Virot, World Lung Foundation

23. Resources

24. Patient IEC Resources Use IEC materials to support patient education –leaflets –posters –videos Acquire IEC materials from –BNTP –TB Training and Education Resource Website www.findtbresources.org

25. WWW.FINDTBRESOURCES.ORG Website includes TB training and education materials from around the world Many materials can be adapted to local Botswana needs