Qualitative Study of Acceptability, Benefits, and Feasibility of a Food-based Intervention among Participants and Stakeholders of the RATIONS Trial
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Background
A qualitative study was conducted during the Reducing Activation of Tuberculosis by Improvement of Nutritional Status (RATIONS) trial to explore the perceptions, experiences, and expectations of participants and stakeholders on the acceptability, benefits, and feasibility of the nutritional intervention.
Methodology
We recruited 58 individuals for in-depth interviews (IDI) and focus group discussions (FGDs) using referential sampling. These included patients with TB (PwTB), household contacts (HHCs), and stakeholders such as trial team members, government frontline workers (the Sahiyas), and National TB Elimination Program (NTEP) staff. All IDI and FGDs were audio-recorded, transcribed, and translated. The codes were generated using an inductive process and categorized manually into themes. Direct quotes were employed to describe the themes.
Results
The intervention was found to be acceptable in terms of cultural compatibility, quality, quantity, and duration; considered beneficial in helping tolerate the adverse effects of medications, gain of weight, improvement of health, and resuming work; and was considered life-saving by many during the COVID-19 pandemic. Other observations included food-sharing in the control arm, inability to regain pre-disease functional status despite weight gain, and preference for either in-kind support or preference for both cash and food support in-kind. The Sahiyas favored this food-based intervention because they observed reduced TB deaths, improved adherence, and better functional recovery. They expressed confidence in its feasibility and willingness to take responsibility for its implementation. The field staff found it challenging in the context of a trial due to the added responsibilities of rigorous data collection but found it important and gratifying. The NTEP staff considered it feasible, provided the necessary resources were provided. Many favored the extension of food support to the HHCs of PwTB.
Conclusions
The qualitative inquiry revealed that the food-based intervention for the PwTB and their HHCs was acceptable, feasible, and beneficial for the recipients and the NTEP. Participants suggested the extension of nutritional support in some areas, as well as enhanced cash support and nutritional support to patients with all forms of TB and their HHCs. Opinion on cash or support in kind was divided; many preferred food support over cash, but others expressed a requirement for both.
