https://orcid.org/0000-0001-8503-3167
Abstract
Purpose
China is the second highest tuberculosis (TB) burden in the world, and TB patients in the rural areas are about twice as many as urban patients. The purpose of present study was to explore the roles of medication adherence, doctor–patient trust and communication on treatment effects, and its inequality between urban and rural areas.
Methods
There were 564 eligible TB patients, from four tuberculosis hospitals in China, participating in this cross-sectional study. They filled out questionnaires regarding socio-demographic characteristics, medication adherence, treatment effect, doctor–patient trust, and communication. The structural equation model (SEM) was applied to explore the hypotheses in this study. All statistical analysis was done by SPSS 25.0 and Mplus 7.0 statistical software.
Results
This study included 267 (47.34%) urban and 297 (52.66%) rural eligible TB patients. The data fitted the research model well, and the urban TB patients reported better treatment effect than the rural ones (P=0.027). Overall, treatment adherence positively predicted treatment effect (Est.=0.353, P<0.001); doctor–patient communication positively influenced treatment adherence (Est.=0.214, P=0.002); and treatment adherence positively mediated the role of communication on treatment effect (Est.=0.076), 95% CI (0.026, 0.152). While in the grouping model, the urban patients’ treatment effect was only influenced by adherence (Est.=0.286, P=0.003); for the rural patients, treatment adherence (Est.=0.464, P<0.001) and doctor–patient trust (Est.=0.382, P=0.019) directly predicted treatment effects, and treatment adherence positively mediated the role of doctor–patient communication on treatment effect (Est.=0.175, P=0.006).
Conclusion
The treatment effect of TB patients, from urban and rural China, was influenced by a different mechanism, among which rural TB patients need not only improve the treatment adherence but also establish good doctor–patient trust and communication to improve treatment effects. These findings provided a theoretical guide on treatment and control for rural TB patients.
Abbreviations
TB, tuberculosis; SEM, structural equation model; WHO, World Health Organization; CFA, confirmatory factor analysis; F.L., factor loading; CR, composite reliability; AVE, average of variance extracted; DPT, doctor–patient trust; DPC, doctor–patient communication; TE, treatment effect; DF, degree of the freedom; CFI, comparative fit index; TLI, Tucker-Lewis index; RMSEA, root mean squared error of approximation; SRMR, standardized root mean square residual; CI, confidence interval; S.E., standard error; Est, estimate.
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. Finally, we express gratitude to the TB patients who made our study possible.
Author Contributions
All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.
Disclosure
The authors report no conflicts of interest in this work.