Ageing and health J Epidemiol Community Health: first published as 10.1136/jech-2017-209458 on 19 January 2018. Downloaded from Effectiveness of comprehensive social support interventions among elderly patients with tuberculosis in communities in China: a community-based trial Xuhui Li,1,2 Bin Wang,1 Dixin Tan,1 Mengyu Li,1 Dandan Zhang,1 Cong Tang,1 Xiaonan Cai,1 Yaqiong Yan,3 Sheng Zhang,4 Bo Jin,5 Songlin Yu,1 Xunchang Liang,1 Qian Chu,6 Yihua Xu1,2 ► Additional material is ABSTRact the elderly has already become a problem beyond published online only. To view Background With the increasing of ageing neglect for TB control in China. please visit the journal online Advanced age, concomitant diseases and waning (http:// dx. doi. org/ 10. 1136/ population, tuberculosis in the elderly brings a jech- 2017- 209458). challenge for the tuberculosis (TB) control in China. immunity make older people vulnerable to devel- Enough social support can promote the treatment oping TB due to the reactivation of Mycobacte- 1Department of Epidemiology adherence and outcome of the elderly patients with rium tuberculosis from infection at a young age.7 8 and Biostatistics, School of TB. Exploring effective interventions to improve the Compared with other people, elderly individuals Public Health, Tongji Medical College, Huazhong University of social support of patients is of great significance for TB with TB need more support because they are more Science and Technology, Wuhan, management and control. likely to experience negative life events, such as China Methods A community-based, repeated measurement reduced mobility, loss of social status, loneliness 2 Ministry of Education (MOE) trial was conducted. Patients with TB >65 years of after retirement, stigma, social isolation, financial Key Lab of Environment and 9–11 Health, School of Public age were allocated into the intervention or control burden and adverse effects of medication. A Health, Tongji Medical College, group. Patients in the intervention group received qualitative study found that educational, psycho- Huazhong University of Science comprehensive social support interventions, while those logical and emotional supports were needed for and Technology, Wuhan, China 12 copyright. 3 in the control group received health education alone. The these patients. Evidence has shown that social Wuhan Municipal Center for social support level of patients was measured at baseline support is positively associated with health-seeking Disease Control and Prevention, Wuhan, China and at the first, third and sixth months during the behaviours, treatment adherence and health 4Gutian Community Health intervention to assess the effectiveness of comprehensive outcomes and that it can act as a stress buffer Service, Wuhan, China social support interventions. for the psychosocial well-being of patients.13–15 5 Xincun Street Community Results A total of 201 patients were recruited However, a study conducted in Zhejiang Prov- Health Service, Wuhan, China 6 into the study. Compared with the control group, ince of China reported that patients with TB had Department of Oncology, Tongji 16 Hospital of Tongji Medical social support for patients in the intervention group a low level of social support. It is meaningful to College, Huazhong University of increased significantly over time β( group*time=0.61, explore feasible and effective social support inter- Science and Technology, Wuhan, P<0.01) in the following three dimensions: objective ventions in communities for TB management and China control. support (βgroup*time=0.15, P<0.05), subjective support http://jech.bmj.com/ (β =0.32, P<0.05) and support utilisation Social support intervention in patients with TB Correspondence to group*time ( =0.16, P<0.05). The change in the scores in the was recommended by WHO for the programmatic Dr Yihua Xu, Department of βgroup*time Epidemiology and Biostatistics, control group was not statistically significant. management of drug-resistant TB and the new End Ministry of Education (MOE) Key Conclusions The intervention programme in TB Strategy.17 Social support via various educa- Lab of Environment and Health, communities, including health education, psychotherapy tional, psychosocial interventions has also been School of Public Health, Tongji and family and community support interventions, can implemented to enhance treatment adherence.14 Medical College, Huazhong improve the social support for elderly patients with TB However, as the types of support, patterns of inter- University of Science and on September 25, 2021 by guest. Protected Technology, Wuhan 430030, compared with single health education. vention, target groups and study settings were China; xuyihua_ 6@ hotmail. com Trial registration number ChiCTR-IOR-16009232 different, the magnitude of the benefit of these social support interventions should be considered Received 13 May 2017 18 Revised 28 November 2017 with caution. Additionally, most of the studies Accepted 6 January 2018 focused on the effect of social support interventions Published Online First INTRODUCTION on treatment adherence or outcomes. Hardly any 19 January 2018 Although great progress in tuberculosis (TB) study assessed the effect of these interventions on control has been made over the last two decades,1 the level of social support patients perceived. The TB remains one of the biggest health problems in social support patients perceived may act as an inter- China.2 3 Concurrently, WHO reported that the mediate variable between the social support inter- burden of TB disease is shifting to the elderly,4 as vention and the treatment adherence or outcomes. the proportion of the older population will increase Exploring the effect of social support interventions from 12.4% in 2010 to 28% in 2040 in China.5 on the level of social support of patients can help To cite: Li X, Wang B, Tan D, According to the fifth national TB survey conducted to understand how social support intervention et al. J Epidemiol Community in China in 2010, the TB prevalence increased with influences the treatment adherence or treatment Health 2018;72:369–375. age and peaked in the 75–79 age group.6 TB in outcomes of patients. Li X, et al. J Epidemiol Community Health 2018;72:369–375. doi:10.1136/jech-2017-209458 369 Ageing and health J Epidemiol Community Health: first published as 10.1136/jech-2017-209458 on 19 January 2018. Downloaded from To the best of our knowledge, no research has explored inter- Interventions ventions to improve the social support of elderly patients with This study lasted for 6 months with an intervention frequency TB in China. Therefore, based on the hypothesis that compre- of twice per month. Patients in the control group received the hensive social support interventions might increase the social health education intervention alone, and those in the interven- support of the elderly with TB, we conducted this communi- tion group received psychotherapy and family and community ty-based trial to assess the effects of the comprehensive interven- support interventions in addition to health education. Except for tions on the improvement of social support of elderly patients the psycho-educational workshops in the family and community with TB. support interventions, these interventions were performed in a one-to-one setting rather than a group setting to avoid cross-in- fection among patients. METHODS Study settings This study was conducted in Hubei Province, China, from Health education November 2015 to April 2016. Hubei Province is one of the Health education consisted of basic knowledge about TB top 10 high TB-incidence provinces in China and the Directly (including transmission route, treatment policy, therapeutic Observed Treatment, Short-course (DOTS) strategy has been regimen), psychological coping skills (including treatment well implemented among its communities.19 After treated in side effects, effective communication, confidence enhance- hospitals for the intensive phase, patients with TB are treated ment), reasonable diet (including light diet, low salt and fat as outpatients in communities. Community health centres are diet, high protein diet) and healthy lifestyle (including smoking responsible for the management of these patients with TB. and drinking cessation, regular physical exercise). TB health All patients with TB that are newly diagnosed in all medical brochures were also delivered to the patients. It was conducted institutions must be reported to the local Centers for Disease by community health workers at patients’ homes and lasted Control and Prevention through the internet-based National approximately 30 min per patient. Infectious Diseases Reporting System (NIDRS).20 So infor- mation on patients with TB, such as gender, age, occupation before retirement, diagnosis date and sputum smear result, Psychotherapy was collected from the NIDRS. To eliminate the mental health problems of patients, Morita therapy was delivered to patients at their home by psychologists of the Tongji Research Center of Mental Health at Tongji Medical Sample size College, Huazhong University of Science and Technology. A As the social support scores of patients were designed to be checklist of the key components of Morita therapy was devel- copyright. measured four times during the study, the sample size was oped according to prior studies23–25 before the intervention and calculated according to the repeated-measures formula: M=2 was strictly followed during the intervention. Throughout the 2 2 2 21 [1+(k-1)ρ]