The effects of family, society and national policy support on treatment adherence among newly diagnosed tuberculosis patients: a cross-sectional study

Abstract

Background: Non-adherence to tuberculosis (TB) treatment is the most important cause of poor TB outcomes, and improving support for TB patients is a primary priority for governments, but there has been little research on the effects of family, social and national policy support factors on TB treatment adherence. The current study evaluated treatment adherence among newly diagnosed TB patients in Dalian, northeastern China, and determined the effects of family, society, and national policy support factors on treatment adherence. Methods: A cross-sectional survey was conducted among newly diagnosed TB patients treated at the outpatient department of Dalian Tuberculosis Hospital from September 2019 to January 2020. Data were collected using a questionnaire that measured medication adherence, family support, social support, and national policy support and so on. Differences between groups were assessed using Chi-square tests and Fisher's exact tests. Ordinal logistic regression analysis was used to determine the predictors of adherence. Results: A total of 481 newly diagnosed TB patients were recruited, of whom 45.7% had good adherence, and 27.4 and 26.8% had moderate and low adherence, respectively. Patients who had family members who frequently supervised medication (OR:0.34, 95% CI:0.16-0.70), family members who often provided spiritual encouragement (OR:0.13, 95% CI:0.02-0.72), a good doctor-patient relationship (OR:0.61, 95% CI:0.40-0.93), more TB-related knowledge (OR:0.49, 95% CI:0.33-0.72) and a high need for TB treatment policy support (OR:0.38, 95% CI:0.22-0.66) had satisfactory medication adherence. However, patients who had a college degree or higher (OR:1.69, 95% CI: 1.04-2.74) and who suffered adverse drug reactions (OR:1.45, 95% CI:1.00-2.11) were more likely to have lower adherence. Conclusions: Our findings suggested that non-adherence was high in newly diagnosed TB patients. Patients who had family members who frequently supervised medication and provided spiritual encouragement and a good doctor-patient relationship and TB-related knowledge and a high need for policy support contributed to high adherence. It is recommended to strengthen medical staff training and patient and family health education and to increase financial support for improving adherence.

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

“…In Xizang, large families live together in multi-generational households and all participants discussed their families as providing social support in relation to their care. Other studies in Xizang, as well as other areas of China, have highlighted the importance of social and family support in TB care on adherence, particularly amongst newly diagnosed patients [ 26 , 64 ]. A 2014 review reported that family treatment observation combined with health worker home visits, as in our setting, can achieve high cure rates if overall treatment is closely monitored and well-connected to the healthcare system [ 65 ].…”

Risk Factors of Pulmonary Tuberculosis and Countermeasures: A Literature Review

“…There are five family functions: The affective function, socialization, social placement function, the health-care function, the reproductive function, and the economic function [36]. It has always been recommended that medical professionals, patients and family members medication management be strengthened and that budgetary funding for enhancing commitment be increased [37]. Therefore, in realizing adequate health service facilities to control pulmonary TB, it is necessary to provide quality health services such as health counseling rooms [38].…”

Treatment Adherence among Tuberculosis patients: A Concept Analysis

“…Many studies have reported on factors that influence adherence to TB treatment, including age, employment, and lifestyle choices, such as consuming alcohol [46], [47]. Other intrinsic factors that influence treatment adherence are knowledge about TB [47], [48], [49], including drug side effects and having a positive self-image and self-awareness [50]. In contrast to adherence, a factor that influences nonadherence to TB treatment is the side effects of the medication.…”

“…External factors that influence adherence to TB treatment consist of three aspects: family and social environment, health professionals, and policy. Support comes from family members, including family members that supervise TB medication frequently and provide spiritual encouragement [48]. Encouragement provided by family members can increase patient confidence in adhering to treatment.…”

“…Another external factor has to do with health professionals who have good relationships and communication with TB patients [48], and provide psychological counseling [12], [49]. The relationship between health professionals and patients can be improved by health professionals by providing strategies, such as home visits and telephone supervision [53].…”