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

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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.
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Keywords: Health Belief Model; behaviour change; health seeking

Document Type: Research Article

Affiliations: 1: London School of Hygiene & Tropical Medicine, London, UK 2: Malawi-Liverpool Wellcome Trust Clinical Research Programme, Blantyre 3: Department of Microbiology, College of Medicine, Blantyre 4: National Tuberculosis Programme, Lilongwe, Malawi 5: London School of Hygiene & Tropical Medicine, London, UK, Malawi-Liverpool Wellcome Trust Clinical Research Programme, Blantyre

Publication date: September 1, 2018

More about this publication?
  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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