Evaluating the effectiveness of a health literacy Intervention for TB patients having multimorbidity: A mixed-method study.

The project involves developing and pilot-testing a health literacy intervention in the form of fotonovelas (photo-based storytelling booklets) for TB patients with multimorbidity in Odisha, India.

Design & Setting: A quasi-experimental pre–post study will be conducted across six clusters (Tuberculin Units) in Khurda district. About 120 adult TB patients with multimorbidity (TB with HIV/Hepatitis or TB with DM/Hypertension) will be recruited.

**Intervention:**The fotonovelas will be developed through community-based participatory action research, culturally adapted, and validated for readability, credibility, and relevance. The materials will depict patient-centered stories on treatment adherence, self-management, and navigating healthcare. Delivery will be through trained healthcare workers (nurses, treatment supervisors, DOT providers, doctors) at the Tuberculin Units.

Comparator: No separate control group is included; instead, feasibility and effectiveness will be evaluated within the intervention clusters.

Outcomes:

Primary outcomes: feasibility, acceptability, adoption, and appropriateness of the intervention (from both patients’ and providers’ perspectives).

Secondary outcomes: medication adherence, self-management, healthcare utilization and expenditure, quality of life, and self-rated health across baseline, 3-month, and 6-month follow-up.

Sample & Evaluation:

20 participants per cluster, total of 120.

Data will be collected using electronic tools (ODK) with both quantitative and qualitative methods.

Evaluation will follow the Consolidated Framework for Implementation Research (CFIR) and a traffic light system (green/amber/red) to decide progression to a larger trial.

Reporting will adhere to CONSORT guidelines.

Expected Contribution: This will be the first standardized health literacy intervention for TB multimorbidity in India, potentially scalable through Health and Wellness Centers to improve integrated TB care and reduce inequities.