An illustrated booklet for reinforcing community health worker knowledge of tuberculosis and facilitating patient counselling

Background: Community health workers (CHWs) have facilitated the move to decentralise tuberculosis (TB) management, but lack access to information appropriate both for personal use and in patient interaction and education. Aim: To explore the impact of a pictorial-based TB booklet on reinforcing CHW knowledge and facilitating patient counselling. Setting: This study was conducted in local primary health care clinics and the Hospice in Grahamstown, Eastern Cape Province in South Africa. Methods: Quantitative and qualitative methods were used. A simple, 17-page, A5 booklet containing pictograms and simple text was designed in collaboration with CHWs who advised on preferred content. Its influence on knowledge was assessed in 31 CHWs using a 17-item questionnaire in a before-and-after study. The experiences of CHWs using the booklet were qualitatively explored using focus group discussions (FGD) and semi-structured interviews. Results: Overall knowledge increased significantly from 70.6% to 85.3% (p < 0.001) with 8 of 17 questions significantly better answered at follow-up. These addressed meaning of side effects and side effect advice for patients, cause and prevention of TB, action if a dose is forgotten, timing of dose in relation to food intake and the possibility that not all patients are cured. Community health workers reported using the booklet during patient interactions, commenting that it enhanced their confidence in their own TB-related knowledge, improved recall of information and reduced uncertainty. They appreciated the simplicity of the text and its user-friendliness because of the inclusion of pictograms. The booklet was perceived to be valuable as a tool for both patient education as well as improved communication with patients. Conclusion: A simple, user-friendly TB booklet containing pictograms improved CHW knowledge and acted as a valuable tool in patient communication and education.