4.3.2 How should this information be provided?

Effective communication skills are described in Section 4.2. These need to be practised by healthcare providers before they can share the information outlined above as part of health education and counselling.

  1. It is important to form a partnership with the patient before sharing any information. All efforts should be made to have a two-way conversation, rather than the health-care provider just telling the patient facts. Patients should be encouraged to ask questions, information should be repeated to help them understand, and health-care workers should check whether the patients have understood the information by asking short questions. Taking time to make sure that patients understand leads to better treatment outcomes. 
  2. The first question should be: “What do you already know about TB?” Once a health-care provider has found out what a patient already knows about TB, the healthcare provider can focus the discussion on what the patient still needs to know. 
  3. The next question should be: “What questions do you have about TB?” The information about TB can then be personalized to the patient. For instance, it is quite possible that a patient is more interested in treatment options than the cause of TB. Once patients’ questions have been answered, they may be more ready to discuss other important TB subjects. Sometimes, it might be difficult to give all the necessary information during one meeting, so the health-care provider needs to prioritize the information so that the most important questions are answered first.
  4. Next the health-care providers need to ask themselves: “What is the most important information that the patient must understand?” 

    The health-care provider should focus on this most important information during the first educational talks with the patient. The health-care provider should still encourage questions from patients and help them understand information by repeating it or asking them short questions. 

    Questions like “What do you know about your rights?” will communicate better with patients instead of reading them a list of their rights.

  5. Finally, health-care providers should summarize the gaps and mistakes in the patient’s knowledge about TB.

While respecting a patient’s religious beliefs, it is important to explore their health beliefs – particularly those that might make it difficult for the patient to finish treatment. These questions also help to the health-care provider to understand what patients think about their illness or treatment, especially in their cultural context. Most people already have some understanding of TB because it is a common illness. They might also be anxious about their diagnosis or have some worries about the health-care provider and the treatment. These concerns, beliefs and worries must be dealt with as part of health education and counselling. Families may also have their own ideas which might or might not be shared by the patient. Since families have a strong influence on patients’ behaviour, their views also need to be taken into account. This helps to avoid confusion within families with regard to medical advice. The importance of exploring a person’s health beliefs is also relevant to Section 5.4 on counselling for treatment adherence.

In addition to sharing information during visits, educational pamphlets that clearly state facts about TB and its treatment are very helpful. The educational material should be appropriate for all ages, culturally sensitive, presented in local languages and in reader-friendly formats. Digital tools with audio or visual aids are also likely to help patients who may have difficulty reading. Additionally, specific marginalized populations may require special educational efforts.

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