<p>Factors Influencing Medication Nonadherence to Pulmonary Tuberculosis Treatment in Tibet, China: A Qualitative Study from the Patient Perspective</p>

Abstract

Medication nonadherence is one of the most significant obstacles to tuberculosis (TB) control worldwide. Identification of the factors associated with medication nonadherence is important. However, few related studies have been carried out in Tibet. This study aimed to explore factors influencing medication nonadherence to pulmonary TB (PTB) treatment in Tibet, China, from the patient perspective. Patients and Methods: In this qualitative study, seventeen PTB patients in Tibet were recruited by purposive and maximum variation sampling methods. In-depth semistructured interviews were conducted to collect data on factors influencing medication nonadherence, and Colaizzi's seven-step method was used to analyze the data. Results: The medication nonadherence of PTB patients in Tibet was influenced by one or a combination of the following four factors. First, patient-related factors included a lack of knowledge of PTB treatment, poor self-management capability, poor self-regulation capability and misperception of health condition. Second, a medication-related factor was medication side effects. Third, health service-related factors included the poor treatment skills of doctors in primary hospitals and a lack of directly observed treatment (DOT). Last, sociocultural factors included the effect of traditional Tibetan medicine, lack of family member support and discrimination. Conclusion: Multiple interplaying factors influenced medication nonadherence during PTB treatment in Tibet, and the main influencing factors were a lack of knowledge about PTB treatment, poor self-management capability, and the effect of traditional Tibetan medicine. TB health workers in Tibet should provide permanently viewable PTB treatment knowledge materials to PTB patients when oral health education is conducted, find feasible alternative strategies to DOT and establish links to traditional Tibetan medicine hospitals.

A qualitative study of perspectives on access to tuberculosis health services in Xigaze, China

“…As many people seek TTM as primary care, public health efforts should involve the TTM system to reduce diagnostic delay [ 21 ]. Others have reported similar patient experiences in the region and emphasized the need for links between TTM and western TB care [ 26 ]. Similar experiences of first seeking traditional healers or herbal remedies for TB symptoms have been reported globally including in Africa, South Asia and South America [ 34 – 38 ].…”

“…However, in practice, TB care in the region has proven difficult to operationalize for many reasons. Challenges impacting Xizang more broadly, and Xigaze specifically, include a shortage of skilled health workers to provide comprehensive ongoing care, inadequate diagnostic capacity and lab facilities, as well as harsh terrain and weather conditions, which disrupt patient and health workers’ travel thereby limiting ongoing care [ 25 , 26 ]. Despite NTP guidelines calling for DOTS and monthly follow-up, most patients receive self-administered therapy with limited health system contact, which has contributed to a high loss to follow-up across the continuum of TB care.…”

“…Thus, there are significant gaps in TB control and service delivery across Xigaze. Further, there is limited evidence on the patient perspective of TB care in Xigaze, with previous studies focusing on factors relating to non-adherence in Xizang generally [ 26 ].…”

<p>Role of Treatment Adherence, Doctor–Patient Trust, and Communication in Predicting Treatment Effects Among Tuberculosis Patients: Difference Between Urban and Rural Areas</p>

“… 6 , 9 , 10 Besides, doctors, playing the dominant role in treatment process, will also directly influence the treatment effect of TB patients. 11 Patients’ trust in doctors is reflected in patients’ affirmation of doctors’ medical technology, prescription correctness and other treatment factors, and the more patients trust their doctors, the better their treatment effects will be. 12 Additionally, previous studies showed that satisfactory doctor–patient communication during medical services, including an explanation of drug use and illness status, psychological counseling, and so on, was also one of means to improve the treatment effects of patients.…”

“… 3 , 15 The determinants of treatment adherence are complex and the empirical relationship between medical staff and treatment adherence is still lacking. 11 , 16 Doctor–patient trust is one of the important issues in the doctor–patient relationship. 17 The higher the mutual trust, the more confident the patients will be about the treatment service offered by the doctors, and the more active he/she will be to participate in the treatment.…”