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

Figures & data

Figure 1. Overall results from eight steps of Behaviour Change Wheel intervention design.

Table 1. Definitions of interventions functions.

COM-B component	Definition	Example
Physical capability	Physical skills, strength or stamina required to perform the behaviour	Instruct on how to perform the behaviour.
Psychological capability	Knowledge, psychological skills, strength or stamina required to perform the behaviour	Inform about the health consequences of not performing the behaviour
Physical opportunity	Opportunity afforded by the environment involving time, resources, locations, cues, physical ‘affordance’	Demonstration of behaviour
Social opportunity	Opportunities shaped by interpersonal influences, social cues, and cultural norms that affect our thinking and language.	Use TB ambassador to demonstrate the behaviour
Automatic motivation	Automatic processes involving emotions, desires, impulses, inhibitions, drives, and reflexes	Social support, goal setting, behavioral feedback, action planned, set graded task
Reflective motivation	Reflective processes involve self-conscious intentions and evaluations of what is good and bad	Demonstration of behaviour and provide social support
Interventions
Education	Increasing knowledge or understanding	Providing information to promote treatment adherence
Persuasion	Using communication to influence emotions or prompt action.	Using imagery to induce the desire for compliance
Incentivisation	Creating expectation of reward	Using self-prize draws to encourage behavior change.
Coercion	Creating expectation of punishment or cost	Loss of self-prize if found to be non-compliant
Training	Imparting skills	Provide initial and continuous TB updates.
Environmental restructuring	Changing the physical or social context	Promote social influence with support
Modelling	Providing an example for people to aspire to or imitate	Enlist ambassadors/champions to inspire with their stories.
Enablement	Increasing means or reducing barriers to enhance capability or opportunity	Support TB treatment adherence
Restriction	Using rules to limit opportunities for the target behavior (or to encourage the target behavior by limiting competing behaviors)	Limit patient treatment access to those who have undergone comprehensive counselling.

All definitions represent original definitions given by Michie et al. (2014).

Table 2. Identify behavioural change techniques.

Health Education: Face-to-face sessions effectively address knowledge gaps on TB risks and treatment benefits, using standardized materials.

Peer Support: Encouraging patients to share experiences fosters peer support, motivating adherence.

Goal Setting: Providing guidance on goal setting and action planning, supported by personal diaries, enhances adherence.

Behavioral Coaching: Clinicians conduct pre- and post-treatment coaching sessions to monitor progress, address barriers, and reinforce adherence benefits.

Progress Monitoring: Regular feedback on patient progress and treatment outcomes reinforces adherence.

Environmental Cues: Patients are encouraged to use environmental prompts, like notes in daily routines, to reinforce treatment habits.

Self-reward: Patients are guided to reward themselves for adherence milestones, fostering motivation.

Social Support Organization: Encouraging involvement in adherence clubs and educating families reduces stigma and improves support.

Table 3. Linking COM-B components, factors influencing TB treatment non-adherence behaviour, intervention functions and specific intervention strategies suggested by participants.

COM-B Components	Factors influencing treatment non-adherence	Intervention function of the BCW	Example of a specific intervention strategy suggested by Participants	Does the specific intervention strategy meets APEASE criteria?
Psychological Capability:	Lack of TB knowledge and treatment awareness. Strong cultural and religious beliefs Fear of stigma and discrimination. Denial of TB status	Education, training, and enablement	Providing comprehensive initial and ongoing TB counselling and education.	Yes
	Strong cultural and religious beliefs	Education	Educate religious leaders and traditional healers about TB.	Yes
Physical opportunity:	Limited information on treatment side effects, risks of incomplete TB treatment, and alcohol/substance abuse.	Restructuring & Enablement	Providing comprehensive initial and ongoing TB education and counselling.	Yes
Social opportunity	Lack of family and community support.	Enablement	Boost social support	Yes
Reflective Motivation	Perception of TB. Treatment duration perception. Co-morbidities. Advanced age.	Education, enablement	Conduct door-to-door TB campaign.	Yes
	Embarrassment to be seen at the healthcare facility or carrying around own medicines.	Enablement	Engage community TB ambassadors for TB education and suspect identification.	Yes
Reflective motivation	Facility operating hours. Long waiting times at health facilities.	Education, enablement	Conduct a door-to-door TB campaign with comprehensive counseling and ongoing TB education.	Yes
	Healthcare workers’ attitude towards poor communication	Enablement	Promote positivity through patient satisfaction surveys.	Yes

 

Key informant interview with three (3) District TB managers (DM)
Participant number	Position	District	Gender	Age
1	TB district manager	A	Female	50-59
2	TB district manager	B	Female	50-59
3	TB district manager	C	Female	Above 60
Key informant interview with eight (8) Facility operational managers (OPM)
Participant number	Position	Community health center	Gender	Age
4	OPM	A1	Female	40-49
5	OPM	A2	Female	Above 60
6	OPM	B1	Female	50-59
7	OPM	B2	Female	50-59
8	OPM	C1	Female	40-49
9	OPM	C2	Female	50-59
10	OPM	C3	Female	Above 60
11	OPM	C4	Female	50-59
Key informant interview with eight (8) facility TB focal (nurse) persons
Participant number	Position	Community health center	Gender	Age
12	TB focal nurse	A1	Female	40-49
13	TB focal nurse	A2	Female	50-59
14	TB focal nurse	B1	Female	50-59
15	TB focal nurse	B2	Female	40-49
16	TB focal nurse	C1	Female	30-39
17	TB focal nurse	C2	Male	30-39
18	TB focal nurse	C3	Female	40-49
19	TB focal nurse	C4	Female	50-59
key informant interview with sixteen (16) TB patients
Participant number	Position	Community health center	Gender	Age
20	TB patient	A2	Male	18-29
21	TB patient	A2	Male	18-29
22	TB patient	A1	Male	40-49
23	TB patient	A1	Female	30-39
24	TB patient	B1	Male	30-39
25	TB patient	B1	Female	30-39
26	TB patient	B2	Female	40-49
27	TB patient	B2	Female	18-29
28	TB patient	C1	Male	40-49
29	TB patient	C1	Male	50-59
30	TB patient	C2	Male	18-29
31	TB patient	C2	Female	30-39
32	TB patient	C3	Male	18-29
33	TB patient	C3	Male	18-29
34	TB patient	C4	Female	30-39
35	TB patient	C4	Female	40-49
Focus group discussions (FGD) with eighteen (18) Home based care givers per district
Participant number	FGD number	District	Gender	Age
36	FGD 1	A	Male	18-29
37	FGD 1	A	Male	30-39
38	FGD 1	A	Male	30-39
39	FGD 1	A	Female	30-39
40	FGD 1	A	Female	30-39
41	FGD 1	A	Female	30-39
42	FGD 1	A	Female	40-49
43	FGD 2	B	Male	50-59
44	FGD 2	B	Female	30-39
45	FGD 2	B	Female	30-39
46	FGD 2	B	Female	40-49
47	FGD 2	B	Female	18-29
48	FGD 2	B	Female	18-29
49	FGD 3	C	Female	40-49
50	FGD 3	C	Female	40-49
51	FGD 3	C	Female	30-39
52	FGD 3	C	Female	40-49
53	FGD 3	C	Female	18-29

Michie, S., Atkins, L., & West, R. (2014). The Behaviour Change Wheel book – A guide to designing interventions (p. 199). Retrieved from http://www.behaviourchangewheel.com/.

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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.