Module 7: Patient Education

Learning Objectives

• Explain the importance of patient education during the TB treatment process

• Describe the District TB coordinator’s 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

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 patient’s family

• 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

District TB Coordinators’ Role in Patient Education and

Resources

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

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

Effective Communication Skills

Effective Communication Skills

• 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

Ask Questions and Listen

• To understand the patient’s medical history

• To understand the patient’s current knowledge about TB

• Identify and help to solve any problems the patient may have with treatment

• Use open-ended questions

• 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

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?

• 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

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

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”

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

Ask Checking Questions

• Ask patient questions

– to understand the patient’s 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?”

Topics to Discuss

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

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

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

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

Resources

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

WWW.FINDTBRESOURCES.ORG

Website includes

• TB training and education materials from around the world

• Many materials can be adapted to local Botswana needs