Effectiveness of e-learning modules in community-based tuberculosis awareness programs.

Tuberculosis (TB) remains a major public health problem in India, which reported about a quarter of the world's TB cases in 2023. Awareness programs are vital for early diagnosis and treatment, yet reaching rural populations in states like Bihar is challenging because of low digital literacy, poor internet coverage and a reliance on shared devices. This intervention study compared facilitator-supported e-learning modules with a more informal mobile-based education approach to assess which method better improves community TB knowledge. Adults from rural and semi-urban Bihar were assigned at the cluster level to either group sessions at community centres or to self-directed mobile messaging. Both interventions provided identical content tailored to local language and literacy levels and were evaluated using pre- and post-intervention knowledge tests, retention assessments, engagement logs, completion rates, satisfaction surveys and reported willingness to share information. Results showed that the structured e-learning group achieved higher gains in knowledge (37.6% vs 34.1%), stronger retention after four weeks (82.3% vs 77.5%) and higher engagement and completion rates. Participant satisfaction and willingness to discuss TB topics with peers were also higher in the e-learning arm. The study suggests that community-based digital learning delivered through facilitated group sessions can overcome barriers posed by low literacy and variable connectivity and may be preferable to unstructured mobile messaging for TB awareness. Expanding such models alongside digital literacy initiatives could contribute to better TB control.