Effect of Integrating Traditional Tuberculosis Care With Modern Health Care on Case Detection, Cost, and Client Satisfaction in Amhara Region, Ethiopia

Quantitative description Design: Both qualitative and quantitative methods will be used to answer our research questions. Cluster randomized control trial study design will be used to determine the effectiveness of integrating traditional care into modern care on case detection rate (for the first, second, and third objectives). The explanatory sequential design will be used to determine the effect of integrating traditional care and modern care on patient satisfaction (fourth objective). This explanatory sequential design will follow to obtain substantiate evidence from quantitative data which is used to determine whether it has effects on patient satisfaction on integration between the traditional with modern care. In this design, two phases will be involved. The first phase will be an initial quantitative instrument phase, followed by a qualitative data collection phase, in which the qualitative phase builds directly on the results from the quantitative phase. In this way, the quantitative results will be explained in more detail through the qualitative data.

Study participants: Study participants will be TB suspected individuals (i.e., coughs for more than two weeks, and other constitutional TB signs and symptoms such as fever, chills, night sweats, anorexia, and weight loss).

Intervention: Integration is recognized as a multidimensional concept with no singular purpose. Integrated service delivery can be defined as joining inputs, management, organization, and distribution of health services related to diagnostics, treatment, care, rehabilitation, and health promotion as a means of improving health status, access, quality, and continuity of care, consumer satisfaction, and efficiency. There is no literature clearly defining integrating traditional TB care with modern care, but for this study, integrating traditional care with modern care is defined as the collaboration of two systems through referral linkage. TB screening and diagnosis services will be done collaboratively in traditional and modern care services. A referral linkage model will be used to detect TB cases in both traditional and modern care services. Health care providers, traditional healers, priests, pastors, and imams will participate in the integration process. TB detection or diagnosis services will be integrated through referral linkage and strengthening capacity-building strategies. Traditional care centers and modern health care services will work collaboratively to improve TB case detection, reduce care costs, and avoid diagnosis delays. The standardized operational procedure of the full interventional package is described below.

Phase 1: Preliminary phase A preliminary intervention package is developed by inviting TB experts, and language professionals. The training manual is prepared and will deliver for practitioners to increase their knowledge and skill. Based on the provision of training contents, the knowledge gain and skill acquisition will be evaluated. The fidelity of the intervention is developed to monitor the whole implementation activities of the training manual as planned.

Phase 2: Preparation for implementation and refine on a small scale In this phase, numerous activities related to the intervention will be performed. Experts who can implement the intervention will be recruited based on experts' educational status (who have earned a BSc degree and above in nursing or public health or medical doctor), and have research and working experiences at TB clinic. A pilot test will be implemented outside the study area on 10% of the project sample size which is suggested by Connelly LM (2008)(287). Based on pilot findings and experts' judgment, the intervention package will be refined and enriched. Before the actual intervention is administered, a baseline data collection will be conducted on TB case detection rate and diagnostic delay in both intervention and control sites.