Using Incentives and Enablers with Tuberculosis (TB) Patients

Incentives and enablers can be a very effective part of a patient-centered approach to TB case management.

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Adhering to lengthy TB therapy can be very challenging. It is critical that persons with TB take their medications correctly, without skipping or taking partial doses. In addition to using Directly Observed Therapy (DOT) to enhance treatment adherence, incentives and enablers can be a very effective part of a patient-centered approach to TB case management.

What are they?

• Incentives are "small rewards" that encourage clients to complete TB treatment by motivating them with something they want or need.
• Enablers help clients overcome barriers to completing their TB treatment.
• Incentives and enablers do not need to be elaborate or expensive. Bus tokens, taxi service, food, clothing, nail polish, movie passes, toys, juice boxes, gift cards, stickers, or even playing a quick game of cards are just a few examples.
• Incentives and enablers are not "bribes." As a health care professional, you can make a difference by understanding how to use them effectively and conveying a positive, caring attitude. Use incentives to motivate, not coerce.

Using incentives

• Be creative! Tailor incentives and enablers to the individual. Choose something that meets their interests and needs. Ask them what they would like to receive.
• Make a verbal or written agreement early in the relationship. Be clear that if the client keeps all DOT appointments (or goes to their next medical appointment, comes in for a chest x-ray, maintains home isolation, provides information about close contacts, etc.), they will receive the agreed-upon incentive. If the client does not keep their end of the agreement, withhold the incentive. Kindly but firmly explain why the incentive is not being given and what they need to do to start receiving it again.
• Incentives are usually used on an ongoing basis- weekly, monthly, or when key milestones are reached. Tailor this to the individual client.

Using enablers

• Identify barriers that interfere with the client's ability to adhere to the treatment plan and provide something that will help overcome that specific barrier. Examples include:
  • Bus tokens or taxi vouchers to get to clinic appointments.
  • Nutritional supplements like Ensure for someone with a poor appetite.
  • Helping a client apply for Medical Assistance or other programs.
  • Yogurt or applesauce for a child who dislikes the taste of medication.

When not to use an incentive

Using incentives and enablers should not necessarily be routine or "automatic" for all TB patients. Not everyone needs this type of help to finish treatment.