Effects of a HAPA-based multicomponent intervention to improve self-management precursors of older adults with tuberculosis: A community-based randomised controlled trial.

OBJECTIVE: To evaluate the effectiveness of a multicomponent intervention based on the Health Action Process Approach (HAPA) model to improve the self-management precursors of older adults with tuberculosis (TB). METHODS: A cluster-randomised controlled trial was conducted. Older adults with TB in the intervention communities received HAPA-based multicomponent interventions at the beginning of treatment and in the first and sixth months after treatment initiation, and those in the control communities received health education alone. Self-management precursors were measured at baseline and 1 week after each intervention. RESULTS: Among 262 randomized patients, 244 (93%) completed the trial. Compared with the control group, self-management precursor scores for the intervention group increased significantly over time (ßgroup*time = 2.92, p < 0.001) in the following 3 precursors: behaviour belief (ßgroup*time = 0.35, p < 0.001), behaviour plan (ßgroup*time = 0.72, p < 0.001), and self-efficacy (ßgroup*time = 1.85, p < 0.001). Education was significantly associated with behaviour belief (ß = 0.18, p < 0.05). Chronic comorbidity was significantly associated with behaviour plan (ß=-0.26, p < 0.05). CONCLUSION: Compared with single health education, the HAPA-based multicomponent interventions significantly improved the self-management precursor of older adults with TB. PRACTICE IMPLICATIONS: This HAPA-based multicomponent intervention strategy may be a promising self-management mode for the routine health care of TB patients.

Effectiveness of comprehensive social support interventions among elderly patients with tuberculosis in communities in China: a community-based trial.

BACKGROUND: With the increasing of ageing population, tuberculosis in the elderly brings a challenge for the tuberculosis (TB) control in China. Enough social support can promote the treatment adherence and outcome of the elderly patients with TB. Exploring effective interventions to improve the social support of patients is of great significance for TB management and control. METHODS: A community-based, repeated measurement trial was conducted. Patients with TB >65 years of age were allocated into the intervention or control group. Patients in the intervention group received comprehensive social support interventions, while those in the control group received health education alone. The social support level of patients was measured at baseline and at the first, third and sixth months during the intervention to assess the effectiveness of comprehensive social support interventions. RESULTS: A total of 201 patients were recruited into the study. Compared with the control group, social support for patients in the intervention group increased significantly over time (ßgroup*time=0.61, P<0.01) in the following three dimensions: objective support (ßgroup*time=0.15, P<0.05), subjective support (ßgroup*time=0.32, P<0.05) and support utilisation (ßgroup*time=0.16, P<0.05). The change in the scores in the control group was not statistically significant. CONCLUSIONS: The intervention programme in communities, including health education, psychotherapy and family and community support interventions, can improve the social support for elderly patients with TB compared with single health education. TRIAL REGISTRATION NUMBER: ChiCTR-IOR-16009232.

Identification of Risk Factors of Multidrug-Resistant Tuberculosis by using Classification Tree Method.

Multidrug-resistant tuberculosis (MDR-TB) has become a major public health problem. We tried to apply the classification tree model in building and evaluating a risk prediction model for MDR-TB. In this case-control study, 74 newly diagnosed MDR-TB patients served as the case group, and 95 patients without TB from the same medical institution served as the control group. The classification tree model was built using Chi-square Automatic Interaction Detectormethod and evaluated by income diagram, index map, risk statistic, and the area under receiver operating characteristic (ROC) curve. Four explanatory variables (history of exposure to TB patients, family with financial difficulties, history of other chronic respiratory diseases, and history of smoking) were included in the prediction model. The risk statistic of misclassification probability of the model was 0.160, and the area under ROC curve was 0.838 (P < 0.01). These suggest that the classification tree model works well for predicting MDR-TB. Classification tree model can not only predict the risk of MDR-TB effectively but also can reveal the interactions among variables.

[Meta-analysis on risk factors of multidrug resistant tuberculosis in China].

OBJECTIVE: To synthetically evaluate the risk factors of multidrug resistant tuberculosis (MDR-TB) in China. METHODS: Chinese databases (CNKI, Wanfang, SinoMed and VIP) and English database (PubMed) were used to collect studies on risk factors for MDR-TB from 1990 to 2013. Meanwhile, relevant studies were manually retrieved. According to the inclusion and exclusion criteria, studies were screened, data were extracted and quality assessed. A Meta-analysis was performed by using Stata 11.0 software. RESULTS: Twenty five studies on the risk factors of MDR-TB were synthetically and quantitatively analyzed. The results of Meta-analysis showed that factors as: being Han ethnic group, history of tuberculosis treatment, pulmonary cavity, floating population, TB case contact history, regular medication, living in rural areas, and poor economy were associated with the incidence of MDR-TB, the pooled OR values were 3.12 (95%CI: 1.16-8.40) , 5.27 (95% CI:3.60-7.72) , 1.39 (95%CI:1.03-1.87) , 1.69 (95%CI: 1.07-2.68) , 4.34 (95%CI: 1.91-9.86) , 0.23 (95% CI: 0.16-0.35) , 1.86 (95% CI: 1.59-2.18) and 1.62 (95% CI: 1.34-1.96) , respectively. CONCLUSION: Factors as: being Han ethnic group, history of tuberculosis treatment, pulmonary cavity, floating population, TB case contact history, living in rural areas and poor economy were considered to be at risk of MDR-TB while regular medication might be a protective factor to MDR-TB.