The document discusses tuberculosis (TB) statistics, diagnosis and treatment cycles, and insights from user research for TB patients in rural Assam, India. It finds that patients often discontinue treatment due to a lack of awareness about the disease and its treatment. Additionally, the TB information and materials provided are outdated, only in local languages, and do not address patient questions or engage them during waiting periods. A proposed ICT-enabled solution could help increase awareness and motivation to improve treatment adherence.

1. Guided by:
Prof. Keyur Sorathia
© Himanshu seth
ICT Interventions for empowerment
of TB patients in Rural Assam
(c) Himanshu Seh

2. Population
covered by
RNTCP
No. of
suspects
examined
Rate of
change in
suspects
examined
per s+ case
diagnosed
(compared to
previous
year)
Total
patients
registered
for treatment
Annual
new extra
pulmonary
case
notification
rate
Assam*1 302 lakh 147642 -1% 39788 18
Kamrup
district*2
29,00,000 16116 8% 4016 19
Tuberculosis Statistics for Assam and Kamrup
district
*1 :: RNTCP Case Finding and Treatment Outcome Performance, 1999–2010
*2 :: RNTCP Case Finding and Treatment Outcome Performance, 1999–2010(c) Himanshu Seh

3. TB diagnosis and treatment cycle
(c) Himanshu Seh

4. TB diagnosis and treatment cycle – Category 1
(c) Himanshu Seh

5. TB diagnosis and treatment cycle – Category 2
(c) Himanshu Seh

6. Patient Identity Card
•
•
(c) Himanshu Seh

7. • According to the guidelines of RNTCP, patients
need to take medication under direct supervision
of the DOTS provider.
• If the patient lives in the vicinity of the ASHA's
home, then ASHA takes the patient's medicine to
her home and gives her medication
personally(either by calling them to her home/or
by going to theirs), however in rest of the cases
the patients have to visit the DOTS Provider.
However, number of people visiting are more
than those attended by ASHA.
TB Medication
(c) Himanshu Seh

8. • The patients are required to take some gaps
between every tablet. It depends upon the
condition of the patient. They are however
instructed to take after every 10 mins. Can be
less / more according depending on the patients
during the medication.
(Avg. duration of medication : 30 mins)
• The Health visitors/professionals are supposed to
make a home visit for every defaulter and have
to enquire about the same and provide
counseling to the patient.
TB Medication
(c) Himanshu Seh

9. TB Medications Boxes (retained by the DOTS provider)(c) Himanshu Seh

10. TB Medicine Blisters. Category - 1(c) Himanshu Seh

11. ASHA Showing the medicines taken by the patients
• Patients are supposed to collect the empty blisters and submit them to the
hospital when the medication gets over.
• ASHA uses the phone throughout the day for making and receiving calls.
Carries her phone in her hand (signifying she is confident carrying it)(c) Himanshu Seh

12. CONTEXTUAL USER RESEARCH
(c) Himanshu Seh

13. 10Patients
6 Contextual Enquiries
4 Observations
(c) Himanshu Seh

14. 5Health Care
Workers
3 Health Technicians
2 Asha Workers(c) Himanshu Seh

15. 4DOTS
Providers
1. Bishnuram Medhi
Community
Health Center,
Haju, Kamrup
2. North Guwahati
P.H.C, Guwahati
3. Guwahati Medical
College, Guwahati
4. Amingaon Sub
Center
(c) Himanshu Seh

16. INSIGHTS AND OBSERVATIONS
(c) Himanshu Seh

17. • Patients discontinue medication at their own will and do not
follow a proper treatment schedule. Reasons : A) they think they have
completely recovered, when the medicines start showing effect. B) they are demotivated to take
medicines (due to the strong dose and they are supposed to visit the center every time) C) some
have to take an off from.
(c) Himanshu Seh

18. • Patients discontinue medication at their own will and do not
follow a proper treatment schedule. Reasons : A) they think they have
completely recovered, when the medicines start showing effect. B) they are demotivated to take
medicines (due to the strong dose and they are supposed to visit the center every time) C) some
have to take an off from.
• Patients fake symptoms in front of the professionals to escape
from the medicines. (c) Himanshu Seh

19. • Unawareness about the disease (its cause and prevention, what
kind of disease they suffer from etc.)
• Unawareness about the tests and checkups
• No information about govt. policies
(c) Himanshu Seh

20. Lack of time and unawareness among ASHA members
• Asha does not have time to sit/observe medications for every patient, so she
leaves the medicine behind with the patient. i.e. DOTS is not practiced.
• Dependence on Asha for procuring the medicines(c) Himanshu Seh

21. Unawareness, shyness and local practices
• Medications have strong side effects and patients have queries
regarding the same.
• Local pharmacist are consulted for medications for side effects,
instead of the doctors/professionals.(c) Himanshu Seh

22. • People feel awkward/shy while approaching the
doctors/professionals.
• Patients want to know more about the disease
• The patients are able to read instructions on the ID card.
(c) Himanshu Seh

23. Unawareness
about the disease
in the patient’s
family
Contextual Enquiry(c) Himanshu Seh

24. Lack of information
• Lack of information mediums (boards, leaflets, cards etc.) at the
place of DOTS providers and in villages.
• Lack of material in regional languages.(c) Himanshu Seh

25. Outdated Information Board in N.G.P.H.C(c) Himanshu Seh

26. No Information Board in the waiting area (N.G.P.H.C)(c) Himanshu Seh

27. No Information Board about TB in any language
Site :: Bishnuram Medhi Community Health Center, Haju, Kamrup
(c) Himanshu Seh

28. Information Boards are in a poor condition and
in Assamesse language only.(c) Himanshu Seh

29. Information Boards are in Assamesse language only.(c) Himanshu Seh

30. Majority of the content printed in the ID cards is in English
Only a little information (General Instructions and Medication dates) are printed in Assamesse.
Patients hardly open the ID card for reference, but keep it safely as advised by the doctors.(c) Himanshu Seh

31. Majority of the content printed in the ID cards is in English
Only a little information (General Instructions and Medication dates) are printed in Assamesse.
Patients hardly open the ID card for reference, but keep it safely as advised by the doctors.(c) Himanshu Seh

32. RNTCP Room, N.G.P.H.C
Patients are entertained in this small room and are asked to sit at a distance while talking.
Absence of Information Boards about the disease
(c) Himanshu Seh

33. (c) Himanshu Seh

34. Waiting area (idle period) in hospitals
• Patients spend time by sitting idle while taking the medications
• Less/no interaction with the professionals in the period of taking medicines at
the facility.
(c) Himanshu Seh

35. Waiting area (idle period) in hospitals
• Patients have are entertained from outside the window.
• They have to stand in queues in order to talk to the doctor
(c) Himanshu Seh

36. Waiting area (idle period) in hospitals
• Patients have to wait outside the center if the appointments get cancelled.
• Patients think that if they go to medical they will have to wait because it’s a
very busy hospital , might lead to demotivation.
Waiting area (idle period) in hospitals
• Patients have to wait outside the center if the appointments get cancelled.
• Patients think that if they go to medical they will have to wait because it’s a
very busy hospital , might lead to demotivation.
(c) Himanshu Seh

37. Social dynamics and peer support
• Patients agree to have received information through peers/villagers.
• No Social Stigma in the society
• Absence of community programs
• Support of family members (husband and mother)(c) Himanshu Seh

38. Technology literacy
• Patients have a mobile phone and they know how to make and receive calls.
• At least one family member (husband) knows how to receive and make calls.
• Use of phone as a shared resource(c) Himanshu Seh

39. Other insights
• Patients prefer face to face interaction to mobile conversation.
• Patients go to DOTS provider for taking medicines.
• Patients are given some basic but very limited instructions by the doctors in
the initial visit. (c) Himanshu Seh

40. Unawareness of tuberculosis among the people
suffering from tuberculosis, leads to hesitation
in medication and sometimes discontinuation of
the treatment in between, which results in a
changes in their treatment category and
duration.
Problem Statement
(c) Himanshu Seh

41. Possible ICT enabled information system will
reach to individual users and increase
information awareness about tuberculosis and
its medication, that will help them to motivate
and ensure their presence during the treatment.
Vision Statement
(c) Himanshu Seh

42. “ Prevention of the disease through better
knowledge and awareness is the
appropriate way to keep disease away
and remain healthy as illness confusion
and health-seeking behavior may enhance
or interfere with the effectiveness of
control measures. ”
Klein RE, Weller SC, Zeissing R, Richards FO, Ruebush TK; “Knowledge, belief
and practices in relation to malaria transmission and vector control in
Guatemala.” Am J TropMed Hyg 1995; 52: 383–8.
(c) Himanshu Seh

43. Thank
You
(c) Himanshu Seh