The Development of Care Model for Pulmonary Tuberculosis, Phlapphla Chai District, Buriram Province.

Abstract

This participatory action research aimed to examine the community-based pulmonary tuberculosis care context, develop a care model, and evaluate the model implemented by the district health network in Phlapphla Chai District, Buriram Province. The study was conducted from April to September 2026 and comprised three phases. Phase 1 involved a situational and contextual assessment among 42 district health network members, 17 tuberculosis care personnel, and 21 successfully treated pulmonary tuberculosis patients. Phase 2 involved model development through the PAOR process with 59 district health network members and tuberculosis care personnel. Phase 3 involved model implementation and evaluation among 20 newly diagnosed smear-positive pulmonary tuberculosis patients and 20 caregivers, totaling 40 participants. Data were collected using questionnaires, focus group discussions, observations, a directly observed treatment monitoring form, and the TB07/1 treatment outcome form. Quantitative data were analyzed using frequency, percentage, mean, standard deviation, and paired samples t-test, while qualitative data were analyzed using content analysis.

            The developed model comprised five components: 1) family-based care, 2) home environmental management, 3) promotion of patient self-care, 4) social stigma reduction, and 5) promotion of patient health behaviors. Following implementation, the patients’ mean tuberculosis knowledge and transmission-prevention score increased from 7.24 (S.D. = 1.44) to 10.93 (S.D. = 0.67), while the caregivers’ mean knowledge score increased from 7.96 (S.D. = 1.15) to 11.40 (S.D. = 0.62). The patients’ mean tuberculosis transmission-prevention behavior score increased from 10.45 (S.D. = 1.38) to 16.17 (S.D. = 1.06). All outcome scores increased significantly following model implementation (p < 0.001). Complete medication adherence was observed in 95.00% of the patients. At the end of the intensive treatment phase, all patients had negative sputum results, and no loss to follow-up, death, or transfer-out was recorded during the three-month monitoring period. Overall satisfaction with the care provided by the district health network was high, with a mean score of 4.46. The developed model connected healthcare facilities, families, and communities and showed potential for improving tuberculosis knowledge, transmission-prevention behaviors, and continuity of treatment among pulmonary tuberculosis patients.