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A Novel Game-Based Approach to Empower Community Health Volunteers for Optimal ADR Management of TB Patients
Tuberculosis (TB) is a chronic infectious disease, and its persistent morbidity and mortality burden remains one of the major public health challenges in India. It is listed as one of the ten most important causes of death from infectious disease in the world. The global TB report published by the World Health Organization (WHO) indicated that about 10 million people, fell ill with tuberculosis in the year 2019.
According to WHO estimates, around 2.7 million people developed TB in India and over 400,000 people died due to TB in the year 2017. By WHO estimates India accounts for 27% of the global estimated 10 million cases and 25% of the estimated 1.6 million deaths. With the exponential population growth in India and fragile healthcare systems, India continues to suffer with a high burden of TB.
TB Requires a Longer Course of Treatment with Multi-Drug Regimens
Medication must be sustained to ensure compliance and optimal success rate. The long course of TB treatment introduces challenges in treatment adherence which is compounded by the fact that multi-drug regimens increase the chance of adverse drug reactions (ADRs). Early identification of ADRs and its effective management are key to successful treatment outcomes.
Importance of Decision-Making by Community Health Volunteers (CHVs)
In India, community health volunteers (CHVs) are frontline stakeholders involved in detecting and reporting TB cases, as well as supporting the treatment of TB patients throughout their treatment cycle. The CHVs are the first point of care for almost all TB patients under care. Early identification of ADRs by these CHVs and a decision to either treat locally or to refer to the Medical Officer is crucial in ensuring patient safety and treatment completion.
Improved education and training of healthcare professionals is a key method to hone decision-making skills and boost confidence of the health workforce. Current training methodologies utilize traditional classroom approaches. Information is taught via text and images to passive learners who may not take up an active role in learning. It is important to train CHVs to:
- Know when an ADR is mild and how to reassure patients in such cases
- Know when an ADR is progressing to a more serious presentation, and refer to the medical officer
- Immediately identify and refer severe ADRs
Manuals and training guidelines developed by authorities to train community health volunteers are often monotonous and lengthy. In such traditional training methods, the target audience feels the pressure to understand the subject thoroughly but in a rigid manner.
How do we make learning more interesting?Game-based learning triggers the visual, creative, emotional, social, and motivational parts of the brain. Learners acquire skills or information through playing a game. This style of learning converts instructional information into a game that students may play. Gamification uses game aspects in non-game contexts to improve material understanding and knowledge retention. Games can allow students to interlink various aspects and see a subject from a multidimensional perspective.
Advantages of a Game-Based Learning are:
- Increased learner motivation levels
- Improved knowledge retention
- Better learner engagement through social mechanisms like badges, points, or leader boards. A user performs well in games and feels validated about his or her knowledge whereas in a traditional training set up they might not answer a question immediately due to anxiety or just lack of interest.
A hybrid learning model that blends traditional and innovative training techniques is time-efficient for trainers and engaging to the learner since there is a mix of various training elements.
In India, game-based learning in the public health domain can revolutionize capacity building of healthcare professionals. Game-based learning can be used by facilitators for training on communicable and non-communicable diseases, vector borne diseases, reproductive and child health etc. Users gain an immersive experience of complex subject matters which may otherwise be difficult to understand. This is especially true for field workers like community health volunteers, ASHAs and ANMs who, through game-based learning, can enhance their critical and strategic thinking skills.
Introducing the ‘Spot the ADR’ Game
In India, almost all CHVs have smartphones and are well acquainted in using smartphone-based applications. Leveraging this opportunity, the Empower School of Health in collaboration with the National TB Institute, Bangalore developed the “Spot the ADR Game” which will engage and educate CHVs through an interactive and gamified learning experience. The Spot the ADR game is simple, engaging and can be played on both laptops, tablets, and smart phones. It incentivizes the CHVs to actively think and make decisions about real-life situations they encounter in their daily lives.
This pioneering gamified approach for training is the first of its kind in a National Health Program in India. Empower School of Health and NTI Bangalore take great pride in introducing this innovative method for ADR management designed specifically for CHVs. It further enhances Empower School of Health's dedication to introducing cutting-edge e-learning initiatives, particularly in the realm of TB control in India.
About the author:Dr Poulami Mazumder works with the Empower School of Health as a Public Health Associate. A development sector professional, she has developed a keen interest in digital health, health systems, and health communications.