Directly Observed Therapy Providers’ Practices When Promoting Tuberculosis Treatment in a Local Thai Community

Abstract

Background: Directly observed therapy (DOT) recommends improving adherence to tuberculosis (TB) treatment by observing patients while they take their medication. Although the practice of DOT providers has been widely studied and promoted, the practice on a community level has to be considered. The aim of this study was to explore experiences of village health volunteers (VHVs) and the family members (FMs) as DOT providers in a local Thai community. 

Methods: This qualitative study involved five focus groups with 25 VHVs, and six FMs who discussed their experiences as DOT providers in a local Thai community. An inductive content analysis was performed. 

Results: It was found that the participants’ descriptions of their experiences as DOT providers could be divided into two themes - their role and skills and the barriers to the practice of DOT. Their role and skills included the monitoring, promoting and cooperating activities. The barriers to the practice of DOT involved practical problems of advising and documenting. 

Conclusions: We found that the DOT providers themselves need to be empowered in their role to empower the TB patients to address their problems and get control of their own situation as well. The DOT providers need to be empowered through improved training, which, in turn, will increase patient autonomy to adhere to the TB treatment. If such training is also given to the FMs they can better act as DOT providers as well. The results may guide the health practices and indicate effective policies for improving the practice of DOT in a local community, especially in high TB burden countries.