Development of a Patient-Centered Community-Based Tuberculosis Care Model, Nathom District, Nakhonpanom Province

Abstract

The purpose of this action research was to develop a patient-centered tuberculosis care model in the community. The target sample were 56 stakeholders in Na Thom District, Nakhon Phanom Province, consisting of tuberculosis patients, caregivers, multidisciplinary teams, and community health networks. The development process employed the PAOR model for one cycle. Quantitative data were collected using questionnaires, and qualitative data were collected using focus group discussions, in-depth interviews, and participant observation. Data were analyzed using descriptive statistics: mean, percentage, standard deviation and Wilcoxon signed rank test. Qualitative data were analyzed using content analysis. Results found that most tuberculosis patients primarily faced medication adherence issues, with healthcare units providing insufficient home visits and medication supervision. The development of a patient-centered community tuberculosis care model consisted of four stages: 1) assessment of the problem and analysis; 2) development of the operational mechanism and capacity building; 3) support patient practice and monitoring through continuous community activities; and 4) evaluation of an outcome and reflection. The patient-centered tuberculosis care model emphasized home-based healthcare, continuous medication adherence monitoring, and collaboration between caregivers, village health volunteers, community networks, and healthcare professionals who provided support for personal, environmental, economic, and social factors, along with appropriate counseling for patients and families. The results of the development found that significantly increased knowledge about tuberculosis and infection prevention (Z=-5.027, p-value<.001). There were high satisfaction among caregivers (93.33%) and stakeholders (88.46%), and a 93.33% treatment success rate after six months. This model might be applied to tuberculosis care in similar contexts and adapted for other chronic diseases requiring continuous supervision.