The effectiveness of face to face education using catharsis education action (CEA) method in improving the adherence of private general practitioners to national guideline on management of tuberculosis in Bandung, Indonesia

The objective of the study was to determine the effectiveness of CEA method in improving the private general practitioners' (PPs) adherence to the national guideline on the management of tuberculosis patients in Bandung District, Indonesia.A randomized controlled trial was done. For the intervention group, a session of the CEA method was delivered to PPs while brief reminder with provision of pamphlet was used for the comparative group.A total of 82 PPs were included in the analysis. The intervention group showed some positive trends in adherence especially in the use of sputum as first laboratory examination (RR = 1.24) and follow up (RR = 1.37), though not reaching statistical significance. After intervention PPs in CEA group maintained the adherence, but PPs in pamphlets group showed deterioration (score before to after: -12.5).Face to face education using CEA method seems to be as effective as brief reminder with provision of pamphlet in improving the adherence. CEA offers additional information that can be useful in designing intervention programs to improve the adherence to guideline.Mycobacterium tuberculosis infects one-third of the world's population and imposes a global burden of an estimated 8 million new cases and 1.8 million deaths yearly [1]. More than 90% of global tuberculosis (TB) cases and deaths occur in the developing world, where 75% of cases are in the most economically productive age group (15-54 years). An adult with TB loses on average three to four months of work time [1,2].Indonesia with a population of over 220 millions carries the heavy burden of TB. Indonesia still ranks third among the 22 high-burden countries [2]. In Bandung, one of the cities in West Java Province, Indonesia, case detection rate (CDR) did not reach the Indonesia target of 70% [3]. The Government of Indonesia considers TB control to be a high priority within the health-care system [3-5]. A strategy for incremental involvement of the private practitioners in DOTS (Dire