Improving Treatment Self-Management Among TB Vulnerable Populations

While TB interventions have been around for decades now, the attempt through this project was to specifically examine the TB program from the lens of vulnerable populations.

Our definition of vulnerable populations? Those who are, in some way or the other, disadvantaged when it comes to their line of work, or in being easily reached for testing, or in being under constant supervision by a caregiver or a healthcare professional through their treatment journey. This included Bihar Migrants, Industrial Workers, Mining Workers, Urban Vulnerable, Lambada & Koya Tribes, Bodo Tribes and Tea Garden Tribes.

The attempt was to

understand their health-seeking behaviour

for general health issues as well as for TB, culling out the enablers and barriers. And, consequently,

find opportunity areas to develop innovative, non-medical interventions

to increase the propensity of these vulnerable populations to exhibit the desired health behaviours.

This outcome of this project was a set of over 30 tested, iterated ideas ready to be piloted across TUs.

When it came specifically to our core focus of TB, the larger problem to solve for was -

Increase self-management of treatment, especially for scenarios like Covid when the regular functioning of the healthcare system is hampered.

We delved deeper into this problem of self-management by defining the specific steps in the user journey and arrived at hundreds of sharply-defined problem statements.

Here’s one example, concerning patient drop-offs mid-way through TB treatment.

Enabling better patient adherence and self-management-Medicine TrackPack

Medicine packaging that makes it easier for the patient to keep a track of their treatment - on a daily basis. And giving them a clear indication of where they are on their treatment journey.

Countering Decision Fatigue and Cognitive Overload: By focusing on just the 1-attribute of DAY NUMBER and making the tablets and the calendar the same 28-day month cycle.

Goal Gradient: Patients are more likely to adhere when they know they are moving closer to an end goal.

IKEA Effect: When patients see how much effort they’ve already put in, it will nudge them to not give up.

Countering Ostrich effect / What-the-hell effect: Calendar gives the perception of being more in control.

Countering Omission Bias with Certainty-Possibility Effect: Countdown numbering provides proof that every single one of the 168 days is essential for cure, and is a mandate, not a recommendation.

Enabling home-bound patients to be more in control of their treatment-TB Organiser

An organiser with the TB treatment calendar at the fore - helping patients and caregivers at home to track and be in control of their TB treatment journey.

Goal Gradient: Patients are more likely to adhere when they know they are moving closer to an end goal.

IKEA Effect: When patients see how much effort they’ve already put in, it will nudge them to not give up.

Countering Ostrich effect / What-the-hell effect: Calendar gives the perception of being more in control.

Countering Omission Bias with Certainty-Possibility Effect: Countdown numbering provides proof that every single one of the 168 days is essential for cure, and is a mandate, not a recommendation.

Ambiguity aversion: Removing the ambiguity from the long treatment regimen.

Enabling migrant patients to be more in control of their treatment-TB Record Book

A Record Book of the patient’s treatment journey which nudges them to take more control of their own treatment - whether at 1 location or several during their treatment journey, and also triggers them for timely testing, counselling and DBT disbursal.

Goal Gradient: Patients are more likely to adhere when they know they are moving closer to an end goal.

IKEA Effect: When patients see how much effort they’ve already put in, it will nudge them to not give up.

Countering Ostrich effect / What-the-hell effect: Calendar gives the perception of being more in control.

Countering Omission Bias with Certainty-Possibility Effect: Countdown numbering provides proof that every single one of the 168 days is essential for cure, and is a mandate, not a recommendation.

Ambiguity aversion: Removing the ambiguity from the long treatment regimen.

Loss aversion: You have the right to ask for your INR 500 DBT and your free test per month worth INR 300.

Making it easier to trigger suspected TB patients to get tested-TB Jaanch Coupon

A coupon that health-workers give to TB-suspected patients to nudge them for testing This will be used by ASHAs, CCs, RNTCP, Work doctors, Pvt. Doctors, RHPs.

Loss aversion: The pain of losing INR 300 is 2x the joy of winning INR 300.

Scarcity mindset: Increasing the perceived value of the free test by providing a limited window to avail it.

Countering Friction costs: eliminating mental barriers to visit a testing centre.

Authority bias: More likely to pay heed to something that’s official.