https://orcid.org/0000-0001-8503-3167
Abstract
Purpose
Medication adherence is crucial for decreasing the burden of tuberculosis, but few relevant studies have been conducted in northeast China. This study aimed to explore the level of medication adherence among pulmonary tuberculosis outpatients and the predictive factors based on the bio-psycho-social medical model.
Patients and Methods
A cross-sectional multi-center survey was conducted in four tuberculosis medical institutions in Dalian, northeast China. Medication adherence was measured using the eight-item Chinese version of the Morisky Medication Adherence Scale, which divides adherence into three levels. The independent variables consisted of sociodemographic characteristics, treatment factors, knowledge about TB, mental health, and behavioral characteristics. Descriptive statistics, the chi-square test, and multivariate ordinal logistic regression were applied to analyze the data using Stata/MP 14.0.
Results
Among the 564 eligible participants, 236 (41.84%) and 183 (32.45%) exhibited high and medium medication adherence, respectively, but 145 (25.71%) exhibited low medication adherence. Multivariate ordinal logistic regression showed that patients who were older (OR: 1.02, p=0.013) were employed (OR: 1.61, p=0.011), had better tuberculosis knowledge (OR: 1.34, p<0.001), and did not consume alcohol (OR: 1.84, p=0.032) exhibited higher medication adherence. However, patients who did not follow their doctors’ advice to take adjuvant drugs (OR: 0.44, p=0.001), had a history of TB treatment (OR: 1.76, p=0.009), experienced adverse drug reactions (OR: 0.65, p=0.017), experienced stigma (OR: 0.67, p=0.032), and needed supervised treatment (OR: 0.66, p=0.012) exhibited lower medication adherence.
Conclusion
Tuberculosis patients’ medication adherence was not very high and it was influenced by diverse and complex factors involving sociodemographic characteristics, treatment factors, knowledge about TB, mental health, and behavioral characteristics.
Acknowledgments
We thank all 15 interviewers, who came from the School of Public Health at Dalian Medical University, for their efforts in collecting the data. In addition, we are grateful to all the medical personnel from the four investigative districts who contributed to our study. Importantly, we express gratitude to the TB patients who made our study possible. Finally, we thank Dr. Morisky for allowing us to use MMAS-8, and the use of the ©MMAS is protected by US copyright and registered trademark laws. Permission for use is required. A license agreement is available from: Donald E. Morisky, 294 Lindura Court, Las Vegas, NV 89138-4632; [email protected].
Author Contributions
All authors contributed to data collection and analysis, drafted and revised the manuscript, gave final approval to publish the manuscript, and agreed to be accountable for all aspects of the work.
Disclosure
The authors report no conflicts of interest in this work.