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Module 7: Patient Education
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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
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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
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• 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
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District TB Coordinators’ Role in Patient Education and
Resources
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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
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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
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Effective Communication Skills
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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
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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
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• 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
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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?
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• 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
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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
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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”
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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
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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?”
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Topics to Discuss
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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
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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
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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
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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
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Resources
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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
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WWW.FINDTBRESOURCES.ORG
Website includes
• TB training and education materials from around the world
• Many materials can be adapted to local Botswana needs