Enhancing TB treatment adherence through the application of the Behaviour Change Wheel

Abstract

Non-adherence to tuberculosis (TB) treatment poses a significant challenge, leading to multidrug-resistant TB and extensively drug-resistant TB. Addressing TB treatment non-adherence is crucial for curing individual patients, controlling TB spread, and reducing TB drug resistance. This study aimed to enhance TB treatment adherence through the application of the Behaviour Change Wheel. The BCW guide was followed to develop the intervention strategy for improving TB treatment adherence among patients. The process involved eight steps across three stages: understanding the behavior, identifying intervention options, and determining content and implementation options. Stage 1 data comprised 16 interviews with TB patients, three with TB district managers, eight with facility operation managers, eight with facility TB focal persons, and three focus group discussions with 18 direct observed treatment supporters. Findings from Stage 1 informed the intervention strategy development. A one-day stakeholder workshop, guided by Stages 2 and 3 of the BCW model, was conducted. The COM-B model analyzed results to identify necessary changes. The BCTv1 taxonomy helped select appropriate behavior change strategies for the intervention. The intervention strategy, named Adherence Improvement Management Strategy (AIMS), was developed through the stakeholder workshop, integrating insights from both approaches and guided by the last two stages of BCW. AIMS involves door-to-door campaigns by community health workers, distributing patient information leaflets to patients, communities, and family members. The BCW framework proved valuable in developing an intervention strategy to enhance TB treatment adherence among patients. Recent research indicates that AIMS is well-structured, patient-centered, coordinated, accessible, safe, and of high quality.

Keywords:

• Behaviour change wheel
• develop
• improve
• intervention strategy
• TB treatment adherence

REVIEWING EDITOR:

• Joe Thomas, Institute of Health and Management, Australia

SUBJECTS:

• Social Influence
• Religion
• Psychology and Nursing

Acknowledgments

The authors wish to thank his PhD mentors Prof T.G Tshitangano, Prof T.X Maluleke, the University of Venda Higher Degrees’ Committee, the University of Venda Research and Ethics Committee, the Department of Health, Limpopo Province, and the Managers of the selected CHCs for granting the permission to conduct the study. The participants are also thanked for their consent to be part of the study. The supervisors are thanked for their tireless efforts and guidance.

Author contributions

HM contributed to the concept, data collection, data analysis, data interpretation and drafting the manuscript. HM contributed to the concept and manuscript review. HM contributed to the concept and manuscript review. HM and TGT contributed to data analysis, data interpretation and manuscript review. HM contributed to the concept, data analysis, data interpretation and manuscript review. All authors reviewed and approved the final version of the manuscript.

Availability of data and materials

The datasets during and/or analysed during the current study are not publicly available due as the researcher strictly agreed with Provincial Department of Health and participants that data will not be for public use as the study involved district managers and facility managers. However, only analysed data are only available from the corresponding author on reasonable request.

Consent for publication

Not applicable.

Disclosure statement

The authors declare no conflict of interest.

Additional information

Funding

The authors thank University of Venda Research and Innovation for funding support (project number: (SHS/19/PH/13).

Notes on contributors

Hulisani Matakanye

Dr. Hulisani Matakanye is a distinguished scholar in the field of public health, holding a Ph.D. in Public Health. As a Senior Lecturer at the University of South Africa, Dr. Matakanye brings a wealth of knowledge, expertise, and passion for advancing public health research and education. With a focus on improving healthcare outcomes and addressing pressing public health challenges, Dr. Matakanye has dedicated their academic career to conducting impactful research and imparting knowledge to the next generation of health professionals. Their research interests encompass areas such as health behavior change, intervention development, and strategies to enhance healthcare adherence. Dr. Matakanye’s academic contributions extend beyond research, as they actively engage in teaching and mentoring students. Through their role as a Senior Lecturer, they play a pivotal role in shaping the academic and professional development of students pursuing studies in public health. Known for their commitment to excellence and innovation in public health, Dr. Matakanye continues to contribute significantly to the academic community and the broader field of public health through research, publications, and academic leadership.

Takalani Grace Tshitangano

Prof. Takalani Grace Tshitangano is an academic mid-level researcher, who holds a Ph.D degree, MBA, and MPH from South African universities. She is a professor of Public health (health promotion). She has graduated with more than thirty-four MPH and 8 PhD students. She has published more than seventy articles in peer-reviewed journals.