Determinants of self-management behaviors among pulmonary tuberculosis patients: a path analysis

Abstract

Background Tuberculosis (TB) is one of the top 10 causes of death in the world. Since Directly Observed Therapy (DOT) as a core strategy for the global TB control are not applicable to all types of TB patients, and self-management of TB patients (SMTP) as a patient-centered supervision type is a supplement to DOT and can improve TB case management. However, the factors related to SMTP are complex and need more study. This study aimed at identifying the determinants of SMTP and examining the direct/indirect effects of these determinants. Methods The purposive sampling technique was used to select study sites and participants were recruited from the study sites by the consecutive sampling method. The PRECEDE model was used as the framework to analyze the determinants of SMTP. The responses of TB patients were acquired via a questionnaire survey for data collection. A Pearson correlation analysis was used to define the relationship between the predisposing, enabling, reinforcing factors with SMTP behaviors. A regression-based path analysis was used to determine the action paths of the predisposing, enabling, and reinforcing factors on SMTP behaviors. Results The predisposing (TB knowledge), enabling [health education and healthcare workers (HCWs) support], reinforcing factors (family support) had significant positive correlations with SMTP behaviors (P < 0.05). The predisposing, enabling, reinforcing factors were positively correlated with each other (r = 0.123‒0.918, P < 0.05), except for family support and HCWs support. The predisposing factors (TB knowledge, β = 0.330) and the enabling factors (HCWs support, β = 0.437) had direct effects on SMTP behaviors. The enabling factors (health education and HCWs support) and the reinforcing factors (family support) had indirect effects on SMTP behaviors. Conclusions This study revealed the effects and action path of TB knowledge, health education, HCWs support, and family support on SMTP behaviors via a path analysis. Assessing patient’s needs for SMTP along with promoting effective TB health education and providing firm support from HCWs and family members are potential strategies to promote SMTP behaviors. Graphic abstract

The habit of indiscriminate spitting in betel chewing

“…16 Facility availability triggers behaviors that allow motivation or actions to be implemented. 17,18 While betel nut chewing is part of the tradition in the Simalungun community, the study results show that the behavior of disposing betel nut saliva indiscriminately is not part of the tradition. Therefore, it can be concluded that this behavior emerges due to a lack of knowledge and negative attitudes among betel nut traders.…”

Effect of Digital Medication Event Reminder and Monitor-Observed Therapy vs Standard Directly Observed Therapy on Health-Related Quality of Life and Catastrophic Costs in Patients With Tuberculosis

“…24,25 TB is not simply confined to the sphere of biomedicine, but also physical, mental, and social sufferings that the current TB treatment strategy exacerbates. [26][27][28] Daily in-person DOT is reported by patients as a tiresome and demanding procedure, [29][30][31][32] and the problem is severe in challenging conditions that impair population mobility, such as the onset of the COVID-19 pandemic. [33][34][35] In this study, the overall EQ-5D-5L median index value was equivalent to a previous score for patients with HIV in Ethiopia.…”

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“…Third, this study did not specifically describe treatment adherence and self-management. There are no clear differences between the accurate meaning and measurement of treatment adherence in a clinical trial setting and those of self-management in a clinical or community context, and few studies have attempted to provide answers [45][46][47]. Fourth, many of the included studies (13/27, 48%) were conducted in LMICs because of the high prevalence of TB cases, even though high-income nations have a considerable number of studies.…”