Multi-Stakeholders' Perspective on Enhancing Health Literacy for Effective Management of Tuberculosis-Multimorbidity in Odisha, India.

PURPOSE: Effective management of tuberculosis-multimorbidity is crucial to reducing disease burden and preventing complications. While studies have explored the role of health literacy in improving TB-treatment adherence and self-management, few have addressed how a collective, multi-faceted approach can optimize the management of TB-multimorbidity. This study aims to bridge these gaps by exploring how various stakeholders perceive health literacy and its role in managing TB-multimorbidity, ultimately providing a more holistic understanding that could guide policy interventions and healthcare strategies in India.

METHODS

A qualitative study was carried out among multiple stakeholders engaged in the management of TB-multimorbidity in Odisha, India. A total of 27 in-depth interviews and 13 key informant interviews were conducted. The data were digitally recorded, transcribed, and translated into English. A thematic framework analysis of stakeholder perceptions, guided by the Health Literacy Instrument for Adults (HELIA), was performed. HELIA informed our interpretation by structuring coding around its literacy dimensions, including access, understand, appraise, and apply, which allows to map interview insights onto literacy-related barriers and facilitators to ground the interpretation of the theme in a validated health-literacy framework.

RESULTS

The findings explored the significance of health literacy in the management of TB multimorbidity. Information gaps exist in TB materials concerning comorbidities. Furthermore, low-literacy patients often faced cultural and semantic challenges, and they relied on community networks; however, the high-literacy patients trusted digital information. The literacy levels many times shape the care plan and patient navigation pathways. The navigation difficulties indicate the possible use of community health workers as trusted guides. The participants suggested including visual tools, improved provider training, and integrated IEC materials addressing multimorbidity, with clear implications for policy and practical healthcare interventions in India to enhance accessibility, trust, and patient-centred care in India.

CONCLUSION

The study indicates the need for concrete and actionable steps to improve TB-multimorbidity management in India, including the development of accessible multilingual materials, enhancing provider training in health literacy and communication, and strengthening trust and navigation through community and system-level supports. We recommend piloting and evaluating these targeted interventions to generate practical guidance for policymakers and practitioners.