The influence of program acceptability on the effectiveness of public health policy: a study of directly observed therapy for tuberculosis.
OBJECTIVE
This study examined how patient acceptability influences the effectiveness of directly observed therapy for tuberculosis.


METHODS
Decision and sensitivity analyses were used in assessing influences.


RESULTS
If mandatory directly observed therapy discourages 6% of initial tuberculosis patients (range: 4% to 10%) from seeking care, then such therapy will be less effective than self-administered therapy. Directly observed therapy is more effective than repeated self-administered therapy for patients failing to complete initial treatment unless 32% (range: 27% to 38%) of patients avoid seeking care.


CONCLUSIONS
Patient acceptability must be taken into consideration before selecting public health strategies.
Heymann
S J
SJ
Department of Health and Social Behavior, Harvard School of Public Health, Boston, MA 02115, USA.
Sell
R
R
Brewer
T F
TF
D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy; D000995:Antitubercular Agents / Q000008:administration & dosage*; D003625:Data Collection; D006291:Health Policy; D006801:Humans; D010342:Patient Acceptance of Health Care; D010349:Patient Compliance; D015397:Program Evaluation; D011634:Public Health; D012646:Self Administration; D014376:Tuberculosis / Q000188:drug therapy*; D018088:Tuberculosis, Multidrug-Resistant / Q000188:drug therapy
D000995:Antitubercular Agents