Ahmad, Siti Rohana
(2018)
Randomised controlled trial on effectiveness of motivational interviewing in diabetes and tuberculosis education within directly observed therapy (MID-DONT) intervention on tuberculosis treatment outcomes among pulmonary tuberculosis patients with diabetes in Kelantan.
Masters thesis, Universiti Sains Malaysia.
Abstract
Incidence of tuberculosis (TB) patients with diabetes mellitus (DM) patients in
Malaysia is rising rapidly. Non-adherence to treatment strategies has been noted as one
of the barriers in achieving successful TB treatment outcome and good glycaemic
control. Motivational Interviewing (MI) has been use in promoting diabetes self-care
among diabetic patients and proven to stimulate patients’ internal motivation to
change. the aim of this study was to evaluate the effectiveness of motivational
interviewing in diabetes and tuberculosis education within directly observed therapy
(MID-DOT) intervention on TB treatment outcomes, glycaemic control and diabetes
self-care activities among TB patients with diabetes. Ten districts in Kelantan, a
northeastern-state in Malaysia, were cluster-randomized into intervention (5 districts
with 15 TB treatment centres) and control group (5 districts with 12 TB treatment
centres). Fifty pulmonary tuberculosis patients with diabetes were recruited in the
intervention group to receive the MID-DOT intervention program (24 sessions of 30
minutes each comprising face to face diabetes self-care and TB education using MI
approach every week for 6 months which were delivered by the TB nurses within DOT
program), while 47 patients in the control group received standard health education.
The primary endpoint was the proportion of patients achieving successful TB
treatment outcome after 6-month TB treatment course. Secondary endpoints were the
changes of glycosylated haemoglobin (HbA1c) level and diabetes self-care score at
baseline, 3rd month and 6th month of intervention period. Primary analysis relied on
intention to treat using Repeated Measures Analysis of Variances (RM Anova).
Successful TB treatment outcome was 94% (cured 76%, completed treatment 18%)
for the intervention group versus 72.3% (cured 53.2%, completed treatment 19.1%)
for the control group with [Relative risk (RR): 1.29, (95% CI 1.56, 22.67)]. A
significance difference of mean HbA1c seen between intervention and control group
at six months of intervention [F(1,58)=16.48, p-value<0.001]. There was a significant
reduction of HbA1c of three-time points for intervention group while for the control
group, no significant reduction was observed. Meanwhile, a significance difference
was also seen in mean diabetes self care activities (DSCA) score between intervention
and control group [F(1,89) =43.51, p-value<0.001]. The mean difference of DSCA
over time was significantly higher in the intervention group (-8.59, 95%CI; -9.98, -
7.18) compared to control group (-0.68, 95%CI;-2.06,0.71). MID-DOT intervention
delivered by TB nurses during DOT session as an adjunct to the standard health
education was shown to be effective in increasing successful TB treatment outcomes
as well as achieving good glycaemic control and diabetes self-care practices. This
innovative dual diseases strategies is highly recommended to be scaled up to
nationwide to reduce TB and DM burden in the country.
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