Increasing the Efficacy of School-Based Directly Observed Therapy: From Needs Assessment to Program Implementation

In 1995, 43 Essex County, New Jersey, children received school nurse directly observed therapy (DOT) for tuberculosis. School-year adherence was 78.5% compared to summer adherence at 93.5%. The only nurse-involved adherence enhancement was individualized education. In early 1996, nurses completed a questionnaire determining DOT challenges. A cross-sectional study later emphasized nurse characteristics and DOT problems and successes. Problems were categorized as student, student’s family, school administration, and school environment. The assessment elicited problem resolutions as education, skills training, and resources; 26% of nurses indicated eliminating school DOT. There were statistically insignificant relationships between nurses’ personal characteristics or reported barriers and student adherence. Resulting interventions included needs-appropriate individual and group education, pediatric nurse case management, and dosing procedure changes. As a result, the 1996 school-based DOT adherence rate increased to 91.1% and continued to be above 90% for 3 consecutive years.