Patient adherence to tuberculosis treatment: a systematic review of qualitative research

Salla A Munro, Simon A Lewin, Helen J Smith, Mark E Engel, Atle Fretheim, Jimmy Volmink, Salla A Munro, Simon A Lewin, Helen J Smith, Mark E Engel, Atle Fretheim, Jimmy Volmink

Abstract

Background: Tuberculosis (TB) is a major contributor to the global burden of disease and has received considerable attention in recent years, particularly in low- and middle-income countries where it is closely associated with HIV/AIDS. Poor adherence to treatment is common despite various interventions aimed at improving treatment completion. Lack of a comprehensive and holistic understanding of barriers to and facilitators of, treatment adherence is currently a major obstacle to finding effective solutions. The aim of this systematic review of qualitative studies was to understand the factors considered important by patients, caregivers and health care providers in contributing to TB medication adherence.

Methods and findings: We searched 19 electronic databases (1966-February 2005) for qualitative studies on patients', caregivers', or health care providers' perceptions of adherence to preventive or curative TB treatment with the free text terms "Tuberculosis AND (adherence OR compliance OR concordance)". We supplemented our search with citation searches and by consulting experts. For included studies, study quality was assessed using a predetermined checklist and data were extracted independently onto a standard form. We then followed Noblit and Hare's method of meta-ethnography to synthesize the findings, using both reciprocal translation and line-of-argument synthesis. We screened 7,814 citations and selected 44 articles that met the prespecified inclusion criteria. The synthesis offers an overview of qualitative evidence derived from these multiple international studies. We identified eight major themes across the studies: organisation of treatment and care; interpretations of illness and wellness; the financial burden of treatment; knowledge, attitudes, and beliefs about treatment; law and immigration; personal characteristics and adherence behaviour; side effects; and family, community, and household support. Our interpretation of the themes across all studies produced a line-of-argument synthesis describing how four major factors interact to affect adherence to TB treatment: structural factors, including poverty and gender discrimination; the social context; health service factors; and personal factors. The findings of this study are limited by the quality and foci of the included studies.

Conclusions: Adherence to the long course of TB treatment is a complex, dynamic phenomenon with a wide range of factors impacting on treatment-taking behaviour. Patients' adherence to their medication regimens was influenced by the interaction of a number of these factors. The findings of our review could help inform the development of patient-centred interventions and of interventions to address structural barriers to treatment adherence.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1. Meta-ethnography Process
Figure 1. Meta-ethnography Process
Figure 2. Search Process and Study Selection
Figure 2. Search Process and Study Selection
Figure 3. Model of Factors Affecting Adherence
Figure 3. Model of Factors Affecting Adherence

References

    1. Dye C. Global epidemiology of tuberculosis. Lancet. 2006;367:938–939.
    1. Corbett EL, Marston B, Churchyard CJ, De Cock KM. Tuberculosis in sub-Saharan Africa: Opportunities, challenges, and change in the era of antiretroviral treatment. Lancet. 2006;367:926–937.
    1. WHO. An expanded DOTS framework for effective tuberculosis control. WHO/CDS/TB/2002.297. Geneva: World Health Organization; 2002. 23. p. Available at: . Accessed:12 October 2006.
    1. Cuneo WD, Snider DE. Enhancing patient compliance with tuberculosis therapy. Clin Chest Med. 1989;10:375–380.
    1. Volmink J, Garner P. Directly observed therapy for treating tuberculosis. Cochrane Database Syst Rev. 2006;2 CD003343. doi: .
    1. WHO. Adherence to long term therapies: Evidence for action. Geneva: World Health Organization; 2003. Available at: . Accessed: 6 February 2006.
    1. Diwan VK, Thorson A. Sex, gender and tuberculosis. Lancet. 1999;353:1000–1001.
    1. Farmer P. Social scientists and the new tuberculosis. Soc Sci Med. 1997;44:347–358.
    1. Vermeire E, Hearnshaw H, van Royen P, Denekens J. Patient adherence to treatment: Three decades of research. A comprehensive review. J Clin Pharmacol Ther. 2001;26:331–342.
    1. Dixon-Woods M, Shaw RL, Sagarwal A, Smith JA. The problem of appraising qualitative research. Qual Saf Health Care. 2004;13:223–225.
    1. Noblit GW, Hare RD. Meta-ethnography: Synthesizing qualitative studies. Newbury Park (CA): Sage; 1988. 88
    1. Britten N, Campbell R, Pope C, Donovan J, Morgan M, Pill R. Using meta-ethnography to synthesise qualitative research: A worked example. J Health Serv Res Policy. 2002;7:209–215.
    1. Barroso J, Gollop CJ, Sandelowski M, Meynell J, Pearce PF, et al. The challenges of searching for and retrieving qualitative studies. West J Nurs Res. 2003;25:153–178.
    1. Mays N, Pope C. Qualitative research in health care: Assessing quality in qualitative research. Brit Med J. 2000;320:50–52.
    1. Malterud K. Qualitative research: Standards, challenges and guidelines. Lancet. 2001;358:483–488.
    1. Rowan M, Huston P. Qualitative research articles: Information for authors and peer reviewers. Can Med Ass J. 1997;157:1442–1446.
    1. Critical Appraisal Skills Programme. Ten questions to help you make sense of qualitative research. 2002. Available: . Accessed 17 January 2005.
    1. Campbell R, Pound P, Pope C, Britten N, Pill R, et al. Evaluating meta-ethnography: A synthesis of qualitative research on lay experiences of diabetes and diabetes care. Soc Sci Med. 2003;56:671–684.
    1. Smith LK, Pope C, Botha JL. Patients' help seeking experiences and delay in cancer presentation: A qualitative synthesis. Lancet. 2005;366:825–831.
    1. Dixon-Woods M, Sutton A, Shaw R, Miller T, Smith J, et al. Appraising qualitative research for inclusion in systematic reviews: A quantitative and qualitative comparison of three methods. J Health Serv Res Pol. 2007;12:42–47.
    1. Schutz A. Collected papers vol 1. The Hague: Martinus Nijhoff; 1971. 361
    1. Khan MA, Walley JD, Witter SN, Shah SK, Javeed S. Tuberculosis patient adherence to direct observation: Results of a social study in Pakistan. Health Policy Plan. 2005;20:354–365.
    1. Khan A, Walley J, Newell J, Imdad N. Tuberculosis in Pakistan: Socio-cultural constraints and opportunities in treatment. Soc Sci Med. 2000;50:247–254.
    1. Jaiswal A, Singh V, Ogden JA, Porter JDH, Sharma PP, et al. Adherence to tuberculosis treatment: Lessons from the urban setting of Delhi, India. Trop Med Int Health. 2003;8:625–633.
    1. Singh V, Jaiswal A, Porter JDH, Ogden JA, Sarin R, et al. TB control, poverty, and vulnerability in Delhi, India. Trop Med Int Health. 2002;7:693–700.
    1. Johansson E, Long NH, Diwan VK, Winkvist A. Attitudes to compliance with tuberculosis treatment among women and men in Vietnam. Int J Tuberc Lung Dis. 1999;3:862–868.
    1. Harper M, Ahmadu FA, Ogden JA, McAdam KP, Lienhardt C. Identifying the determinants of tuberculosis control in resource-poor countries: Insights from a qualitative study in The Gambia. Trans R Soc Trop Med Hyg. 2003;97:506–510.
    1. George LJ. Compliance with medication and directly observed therapy in the treatment of TB in Lesotho. Philadelphia (PA): Faculty of the School of Social Work, University of Pennsylvania; 2003. 300 [PhD dissertation].
    1. Johansson E, Diwan VK, Huong ND, Ahlberg BM. Staff and patient attitudes to tuberculosis and compliance with treatment and exploratory study in a district in Vietnam. Tuber Lung Dis. 1996;77:178–183.
    1. Gleissberg VG. Patient views on tuberculosis: Is compliance with treatment the key to success or beside the point? Uxbridge (United Kingdom): Department of Anthropology. Brunel University; 2001. 55 [MSc thesis.]
    1. Sanou A, Dembele M, Theobald S, Macq J. Access and adhering to tuberculosis treatment: Barriers faced by patients and communities in Burkina Faso. Int J Tuberc Lung Dis. 2004;8:1479–1483.
    1. Greene JA. An ethnography of non-adherence: Culture, poverty, and tuberculosis in urban Bolivia. Cult Med Psychiatry. 2004;28:401–425.
    1. Watkins RE, Plant AJ. Pathways to treatment for tuberculosis in Bali: Patient perspectives. Qual Health Res. 2004;14:691–703.
    1. Edginton ME, Sekatane CS, Goldstein SJ. Patients' beliefs: Do they affect tuberculosis control? A study in a rural district of South Africa. Int J Tuberc Lung Dis. 2002;6:1075–1082.
    1. Joseph HA, Shrestha-Kuwahara R, Lowry D, Lambert LA, Panlilio AL, et al. Factors influencing health care workers' adherence to work site tuberculosis screening and policies. Am J Infect Control. 2004;32:456–461.
    1. Nair D, George A, Chacko K. Tuberculosis in Bombay: New insights from poor urban patients. Health Policy Plan. 1997;12:77–85.
    1. Coleman RL, Wilkinson D, MacAdam KP. Voluntary lay supervisors of directly observed therapy for tuberculosis in Africa. Trop Doc. 1998;28:78–80.
    1. Matebesi Z. Living with TB: The career of the tuberculosis patient in the free state, SA . Bloemfontein (South Africa): Department of Sociology, University of the Free State; 2004. 216 [PhD dissertation].
    1. Menegoni L. Conceptions of tuberculosis and therapeutic choices in Highland Chiapas, Mexico. Med Anthropol Q. 1996;10:381–401.
    1. Dick J, van der Walt H, Hoogendoorn L, Tobias B. Development of a health education booklet to enhance adherence to tuberculosis treatment. Tuber Lung Dis. 1996;77:173–177.
    1. Ellis JHP, Beyers N, Bester D, Gie RP, Donald PR. Sociological and anthropological factors related to the community management of tuberculosis in the western cape communities of Ravensmead and Uitsig. S Afr Med J. 1997;87:1047–1051.
    1. Johansson E, Winkvist A. Trust and transparency in human encounters in tuberculosis control: Lessons learned from Vietnam. Qual Health Res. 2002;12:473–491.
    1. Asamoa K. Social counselling and tuberculosis treatment adherence at Bethania hospital, Sialkot, Pakistan. Heidelberg (Germany): University of Heidelberg; 1998. 64 [Master's thesis].
    1. San Sebastian M, Bothamley GH. Tuberculosis preventive therapy: Perspective from a multi-ethnic community. Respir Med. 2000;94:648–653.
    1. Allen S. The feasibility of implementing brief motivational interviewing in the context of tuberculosis treatment in South Africa. Stellenbosch (South Africa): University of Stellenbosch; 2006. 165 [Master's thesis].
    1. Watkins RE, Rouse CR, Plant AJ. Tuberculosis treatment delivery in Bali: A qualitative study of clinic staff perceptions. Int J Tuberc Lung Dis. 2004;8:218–225.
    1. Pushpananthan S, Walley JD, Wright J. Tuberculosis in Swaziland: A health needs assessment in preparation for a community-based programme. Trop Doc. 2000;30:216–220.
    1. Estcott S, Walley J. Listening to those on the frontline: Lessons for community-based tuberculosis programmes from a qualitative study in Swaziland. Soc Sci Med. 2005;61:1701–1710.
    1. Klink WB. Problems of regimen compliance in tuberculosis treatment. New York (NY): Columbia University; 1969. 275 [PhD dissertation].
    1. Smith AJE, Moore LM. Selective directly observed therapy: Appraisement and perception of likely participants. J Public Health Manag Prac. 1995;1:14–21.
    1. Rowe KA, Makhubele B, Hargreaves JR, Porter JD, Hausler HP, et al. Adherence to TB preventive therapy for HIV-positive patients in rural South Africa: implications for antiretroviral delivery in resource-poor settings? Int J Tuberc Lung Dis. 2005;9:263–269.
    1. Mata JI. Integrating the client perspective in planning a tuberculosis education and treatment program in Honduras. Med Anthropol. 1985;9:57–64.
    1. Ito KL. Health culture and the clinical encounter: Vietnamese refugees' responses to preventive drug treatment of inactive tuberculosis. Med Anthropol Q. 1999;13:338–364.
    1. Fong C. Gender and access to DOTS program (Directly Observed Treatment, Short Course) in a poor rural and minority area of Gansu province, China. Baltimore (MD): Johns Hopkins University; 2004. 138 [PhD dissertation].
    1. Liefooghe R, Michiels N, Habib S, Moran MB, de Muynck A. Perception and social consequences of tuberculosis: A focus group study of tuberculosis patients in Sialkot, Pakistan. Soc Sci Med. 1995;41:1685–1692.
    1. Demissie M, Getahun H, Lindtjorn B. Community tuberculosis care through “TB clubs” in rural north Ethiopia. Soc Sci Med. 2003;56:2009–2018.
    1. de Vos PF. Tuberculosis, adherence behaviour the inner city. Edmonton (Alberta): University of Alberta; 2002. 221 [Master's thesis].
    1. Wares DF, Singh S, Acharya AK, Dangi R. Non-adherence to tuberculosis treatment in the eastern Tarai of Nepal. Int J Tuberc Lung Dis. 2003;7:327–335.
    1. Marra CA, Marra F, Cox VC, Palepu A, Fitzgerald JM. Factors influencing quality of life in patients with active tuberculosis. Health Qual Life Outcomes. 2004;2:58–68.
    1. Wyss L. Beliefs about medication compliance in a migrant population diagnosed with TB. Akron (OH): University of Akron; 2004. 232 [PhD dissertation].
    1. Coreil J, Lauzardo M, Heurtelon M. Cultural feasibility assessment of tuberculosis prevention among persons of Haitian Origin in South Florida. J Immigr Health. 2004;6:63–69.
    1. Curtis R, Friedman SR, Neaigus A, Jose B, Goldstein M, et al. Implications of directly observed therapy in tuberculosis control measures among IDUs. Public Health Rep. 1994;109:319–327.
    1. Dick J, Clarke M, Tibbs J, Schoeman H. Combating tuberculosis—Lessons learnt from a rural community project in the Klein Drakenstein area of the Western Cape. S Afr Med J. 1997;87(Suppl):1042–1047.
    1. Ngamvithayapong J, Winkvist A, Diwan V. High AIDS awareness may cause tuberculosis patient delay: Results from an HIV epidemic area Thailand. AIDS. 2000;14:1413–1419.
    1. Ngamvithayapong J, Uthaivoravit W, Yanai H, Akarasewi P, Sawanpanyalert P. Adherence to tuberculosis preventive therapy among HIV-infected persons in Chiang Rai Thailand. AIDS. 1997;11:107–112.
    1. Sumartojo E. Structural factors in HIV prevention: Concepts, examples and implications for research. AIDS. 2000;14(Suppl 1):S3–S10.
    1. Sumartojo E. When tuberculosis treatment fails: A social behavioural account of patient adherence. Am Rev Respir Dis. 1993;147:1311–1320.
    1. Lienhardt C, Ogden J, Sow O. Rethinking the social context of illness: Interdisciplinary approaches to tuberculosis control. In: Gandy M, Zumla A, editors. The return of the White Plague: Global Poverty and the “new” tuberculosis. London: Verso; 2003. pp. 195–291.
    1. Tulsky JP, Hahn JA, Long HL, Chambers DB, Robertson MJ, et al. Can the poor adhere? Incentives for adherence to TB prevention in homeless adults. Int J Tuberc Lung Dis. 2004;8:83–91.
    1. Horne R, Weinman J. Self-regulation and self-management in asthma: Exploring the role of illness perceptions and treatment beliefs in explaining non-adherence to preventer medication. Psychol Health. 2002;17:17–32.
    1. Horne R, Weinman J. Patients' beliefs about prescribed medicines and their role in adherence to treatment in chronic physical illness. J Psychosom Res. 1999;47:555–567.
    1. Ross S, Walker A, MacLeod M. Patient compliance in hypertension: Role of illness perceptions and health beliefs. J Hum Hypertens. 2004;18:607–613.
    1. Wichowski HC, Kubsch SM. The relationship of self-perception of illness and compliance with health care regimens. J Adv Nurs. 1997;25:548–553.
    1. Pound P, Britten N, Morgan M, Yardley L, Pope C, et al. Resisting medicines: A synthesis of qualitative studies of medicine taking. Soc Sci Med. 2005;61:133–155.
    1. Garner P, Smith H, Munro S, Volmink J. Promoting adherence to tuberculosis treatment. Bull World Health Organ. 2007;85:404–406.
    1. Lewin SA, Skea ZC, Entwistle V, Zwarenstein M, Dick J. Interventions for providers to promote a patient-centred approach in clinical consultations. Cochrane Database of Systematic Reviews. 2001;4 CD003267. doi: .
    1. Berg J, Blumberg E, Sipan C, Friedman L, Kelley N, et al. Somatic complaints and isoniazid (INH) side effects in Latino adolescents with latent tuberculosis infection (LTBI) Patient Educ Couns. 2004;52:31–39.
    1. Chang K, Leung C, Tam C. Risk factors for defaulting from anti-tuberculosis treatment under directly observed treatment in Hong Kong. Int J Tuberc Lung Dis. 2004;8:1492–1498.
    1. Corbett EL, Watt CJ, Walker N, Maher D, Williams BG, et al. The growing burden of tuberculosis: Global trends and interactions with the HIV epidemic. Arch Intern Med. 2003;163:1009–1021.
    1. Nyblade L, Pande R, Mathur S, McQuarrie K, Kidd R, et al. Disentangling HIV and stigma in Ethiopia, Tanzania and Zambia. Washington (D.C.): International Center for Research on Women; 2003. Available at: . Accessed: 18 January 2007.
    1. De Villiers S. Tuberculosis in anthropological perspective. S Afr J Ethnology. 1991;14:69–72.
    1. Armstrong D. From clinical gaze to regime of total health. In: Heller T, Muston R, Sidell M, Lloyd C, editors. Working for health; London: Sage: 2000. pp. 16–27.
    1. Trostle JA. Medical compliance as an ideology. Soc Sci Med. 1988;27:1299–1308.

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