Factors predicting self-report adherence (SRA) behaviours among DS-TB patients under the “Integrated model”: a survey in Southwest China

Abstract

Background China is one of 30 countries with a high tuberculosis (TB) burden, and poor adherence to TB treatment is one of the biggest challenges for TB control. We aimed to explore the barriers and facilitators of treatment adherence among drug-sensitive tuberculosis (DS-TB) patients under the “Integrated model” in Western China, to provide evidence-based treatment and control regimens for DS-TB patients to improve adherence behaviours. Methods Both qualitative and quantitative research methods were used to explore the factors associated with self-reported adherence (SRA) behaviours. Questionnaire surveys with DS-TB patients and in-depth interviews with leaders from the Centers for Disease Control and Prevention (CDC) and community health sectors (CHCs), healthcare workers (HCWs) from CHCs, and DS-TB patients were conducted. Results A total of 459 eligible patients were included in the quantitative survey, and two patients and 13 healthcare providers were included in the in-depth interviews. The percentage of patients who experienced a missed dose, lack of follow-up sputum examination, and interrupted treatment were 19.0%, 11.3%, and 9.2%, respectively. Patients aged 20–39 had a higher risk of missed dose [OR (95% CI): 2.302 (1.001–5.305)] and a lower risk of interrupted treatment [OR (95% CI): 0.278 (0.077–0.982)] than patients more than 60 years. Patients who were of Han ethnicity (OR [95% CI]: 0.524 [0.301–0.912]) received psychological support (OR [95% CI]: 0.379 [0.144–0.998]) from their family and had a lower risk of missed doses. Patients who had drug side effects had a higher risk of interrupted treatment (OR [95% CI]: 2.587 [1.237–5.412]). Patients who possessed higher knowledge had a lower risk of lack of follow-up sputum examination [OR (95% CI): 0.817 (0.673–0.991)]. The results of the qualitative study also reported that patients’ poor TB knowledge was the main reason for their non-SRA behaviours. Conclusions Patient-centred strategies should be implemented to improve health literacy and strengthen psychological support. More effective case management should be designed and implemented based on different patient characteristics to improve adherence behaviours in further studies.

Clinical Characteristics and Outcomes in Chronic Kidney Disease Patients with Tuberculosis in China: A Retrospective Cohort Study

“…On the other hand, in China, approximately 71% of patients with TB live in rural areas and are not treated on time because of their poor economic conditions. 25 , 26 …”

Factors Related to Complying with Anti-TB Medications Among Drug-Resistant Tuberculosis Patients in Indonesia

“… 30 TB patients who received psychological support from their family throughout TB therapy were less likely to skip doses than patients of other ethnicities and those who received no help. 30 Patients with satisfactory medication adherence had family members who frequently supervised medication, family members who frequently provided spiritual encouragement, and more TB-related knowledge. 31 Through medication adherence, directly observed therapy had an indirect, favorable effect on treatment success.…”

“…Family support was significantly related with a missed dose, although there was no difference between interrupted therapy, lack of follow-up examination, and family 3324 support. 30 TB patients who received psychological support from their family throughout TB therapy were less likely to skip doses than patients of other ethnicities and those who received no help. 30 Patients with satisfactory medication adherence had family members who frequently supervised medication, family members who frequently provided spiritual encouragement, and more TB-related knowledge.…”

“…There was no significant connection between symptoms and self-report adherence behaviors. 30 Health-system-related factors included health insurance, and 65.8% of patients had taken out health insurance. Health insurance influences medication adherence positively.…”

“…Emotional anxiety included expressions of care (questions 1-5), encouragement (questions 6-10), and empathy (questions 11-15). The aid domain covered service (questions [16][17][18][19][20], money (questions 21-25), and information (questions [26][27][28][29][30][31]. Affirmation included constructive feedback (questions 32-36) and acknowledgment (questions 37-41).…”