Factors affecting tuberculosis health message recall 2 years after active case finding in Blantyre, Malawi

• Published in: The international journal of tuberculosis and lung disease Vol. 22; no. 9; pp. 1007 - 1015
• Main Authors: Monk, E. J. M., Kumwenda, M., Nliwasa, M., Mpunga, J., Corbett, E. L.
• Format: Journal Article
• Language: English
• Published: France International Union Against Tuberculosis and Lung Disease 01.09.2018; International Union against Tuberculosis and Lung Disease (IUATLD)
• Subjects: Adult; Behaviour Change; Community participation; Disease transmission; Early Diagnosis; Epidemiology; Female; Focus Groups; Health; Health Behavior; Health Belief Model; Health Knowledge, Attitudes, Practice; Health Seeking; Human behavior; Humans; Interviews as Topic; Malawi; Male; Middle Aged; Multivariate Analysis; Original; Patient Acceptance of Health Care; Population studies; Qualitative analysis; Qualitative Research; Recall; Regression analysis; Slums; Surveys and Questionnaires; Tuberculosis; Tuberculosis - diagnosis; Tuberculosis - psychology; Tuberculosis - transmission; Variance analysis; Malawi
• ISSN: 1027-3719; 1815-7920
• DOI: 10.5588/ijtld.18.0006

SETTING: Urban slums, Blantyre, Malawi.OBJECTIVE: To explore tuberculosis (TB) community-wide active case finding (cwACF) recall and accompanying messaging 2 years after the intervention.DESIGN: This mixed-methods study used population-weighted random cluster sampling to select three cwACF-receiving and three non-cwACF-receiving neighbourhoods in Blantyre. Qualitative data were collected using 12 focus group discussions (community peer-group members) and five in-depth interviews (TB officers) with script guides based on the concepts of the Health Belief Model (HBM). Thematic analysis was used to explore transcripts employing deductive coding. Questionnaires completed by focus group participants were used to collect quantitative data, providing a 'knowledge score' evaluated through univariate/multivariate analysis, analysis of variance and multiple linear regression.RESULTS: Community peer-group participants (n = 118) retained high awareness and positive opinions of cwACF and recognised the relationship between early diagnosis and reduced transmission, considering cwACF to have prompted subsequent health-seeking behaviour. TB-affected individuals (personal/family: 47.5%) had significantly higher knowledge scores than unaffected individuals (P = 0.039), but only if resident in cwACF-receiving neighbourhoods (P = 0.005 vs. P = 0.582), implying effect modification between exposures, albeit statistically under-powered (P = 0.229).CONCLUSION: Consistent with epidemiological evidence and HBM theory, cwACF may have a permanent impact on knowledge and behaviour, particularly in communities with a high prevalence of TB-affected individuals. Behaviour change strategies should be explicitly included in cwACF planning and evaluation.