Cost-effectiveness of health education intervention using WhatsApp among tuberculosis patients in improving treatment adherence and successful outcome

Each participant in the intervention group should received the health education module pertaining tuberculosis and its treatment which is developed during this study through WhatsApp. To avoid contamination of the intervention information, all the respondent was asked not to share any content of the WhatsApp they received with others. Type of intervention: Health Education Intervention Module Using WhatsApp (mHealth) Description as below: Implementation method: Eligible respondents received health education module developed for this study through WhatsApp direct to their phone during intensive phase of DOT treatment (this is given once) and then 3 times reminder messages (total 3 messages over 4 months of maintenance phase of treatment). Example of messages are information pertaining Tuberculosis disease, how it spread, how to prevent it spread, the treatment option, what is the implication of not completing treatment and etc. The participant were required to read the messages and try to understand it. If they have any queries, they can ask through whatsApp messages. There are 3 sections in the health education module and each section is sent through whatsApp (total 30 messages and most messages were in picture format) given once in a day duration during 2 months of intensive phase of tuberculosis treatment. Example of reminder messages: "have you finished reading the health information given through WhatsApp and please continue taking your medication until completed") until treatment completed as scheduled. The adherence to medication were monitored through existing documentation for DOT in health clinic. Patients on DOT need to go to the nearest health facilities to take the daily medication. Health care providers will observe the patients swallowing the tuberculosis drugs in front of them and documented it into the TB record book using specific forms (TBIS 10-I) in the clinic and in patients’ home-based card as a proof that the patient had taken the medication. The routine is carried out daily, however, there are exception during weekends or public holiday whereby patients will be given supply of medications to be taken at home based on number of days required and directly observed therapy (DOT) need to be done by other family members or community members or self-reported. The other family members or community members need to document and signed on the patients home-based record book and need to be verified by health care provider upon next visit for DOT at the clinic.