https://orcid.org/0000-0002-1793-0701
Abstract
Purpose
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.
Abbreviations
TB, tuberculosis; PTB, pulmonary tuberculosis; DOT, directly observed treatment; DOTS, directly observed treatment, short course; WHO, World Health Organization; AIDS, autoimmune deficiency syndrome.
Data Sharing Statement
The data used and/or analyzed during the current study are available from the corresponding author on reasonable request.
Ethics Approval and Informed Consent
This study was approved by the Ethical Review Committee of the School of Medicine, Xizang Minzu University (2019015). All procedures performed in this study were in accordance with Helsinki declaration. Participants who were interviewed face to face signed written informed consent in the interview room. Participants who were interviewed by video signed written informed consent in a convenient place and sent a picture of the form to the interviewer. For participants aged < 18 years (15–17 years), written informed consent was obtained from their parents, and assent was obtained from them.
Acknowledgments
We would like to sincerely thank the participants of this study. We are also thankful for the Pulmonary Department of the Third People’s Hospital of the Tibet Autonomous Region.
Author Contributions
JJZ designed the study, conducted the in-depth interviews, and acted as the corresponding author. YYY contributed an amount equal to JJZ in this study; YYY took part in the study design and recruited the participants. TY and PC took part in the in-depth interviews and translated participants’ Tibetan dialect into Mandarin Chinese. All authors contributed to performing the data analysis and drafting or revising the article, gave final approval of the version to be published, and agree to be accountable for all aspects of the work.
Disclosure
The authors report no conflicts of interest in this work.