4. Health education and counselling for people affected with tuberculosis

This section focuses on a key recommendation on patient care and support by providing health education and counselling on the disease and treatment adherence to TB treatment (15, 16).


This recommendation is based on evidence from extensive literature which shows better rates of treatment adherence and completion, and lower rates of loss to follow-up, in patients who received health education and counselling prior to and during the course of TB treatment (15, 23, 36–41). Health education and counselling on TB and its treatment should be provided to all patients.

The goal of health education is to provide accurate information so that patients have the information to make the best choice for themselves. Education can be provided by talking with the patient, distributing written materials, sharing video recordings, or through arts and performance with participation of people affected by TB. The education should discuss TB as a disease, its treatment and the services for which the patient is eligible. The education can and should be given at multiple times during TB treatment both to remind patients of information and also to provide specific information for treatment changes that may be coming up. Education could occur right before or at the start of treatment, when finishing the intensive phase of therapy, or at each presentation or interaction for follow-up care. It can be provided by different types of health-care workers or pharmacists. Educational sessions might include the patient alone or might involve the patients’ family members and/or friends. (15, 16).

While health education aims to equip people with the right knowledge, counselling helps them to apply that knowledge by changing their attitude and behaviour. The term “counselling” refers to a two-way interaction between the patient and the health-care provider. It is an interpersonal, dynamic communication process that involves a kind of contractual agreement between a patient and a healthcare provider who is trained in counselling skills and who is bound by a code of ethics and practice. It requires understanding and concern for the patient without any moral or personal judgement. To achieve this, health-care providers should be taught interpersonal skills in order to build a partnership with patients and to have good communication skills in order to talk with them and strengthen their understanding of TB. The goal is to make the patients feel strong enough to do what they need to do for treatment of their TB disease.

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