The Implementation of Comprehensive Health Education to Improve Household Contacts’ Participation in Early Detection of Tuberculosis

Lack of participation of household contacts is the main problem of early detection of tuberculosis (TB) in Indonesia. A comprehensive health education (CHE) program has been developed to encourage the participation of household contacts. This study aimed to assess the implementation of the CHE to improve participation of household contacts in early detection of TB. This was a quasi-experimental study conducted between November 2018 and June 2019 in Badung District, Bali, Indonesia. Twelve public health centers (PHCs) were randomly allocated to six PHCs implementing the CHE and six PHCs implementing standard health education (SHE). The CHE was developed through a pilot study using the health belief model supplemented with perceived stigma and social support to identify the factors that influence participation. The participation was measured using a TB register with a cross-check to the health care officer until 2 months after health education was provided. Four hundred and twenty-eight household contacts enrolled in this study—216 in the CHE group and 212 in the SHE group. The CHE group’s participation was 28.2%, with 10 new TB cases found; in the SHE group, the participation was 15.6%, with 3 new TB cases found. The CHE increased the household contact participation by 1.83-fold (95% confidence interval [1.19, 2.81]) and case findings by 3.13-fold (95% confidence interval [0.85, 11.56]). The CHE implementation should be scaled up to other areas with a high level of TB transmission. The content and technique of the CHE could also be incorporated in contact investigation guidelines and materials for the TB campaign.