1 Erasmus University, Department of Health Policy and Management (iBMG), Rotterdam, the Netherlands 2 Erasmus University, Institute for Medical Technology Assessment (iMTA), Rotterdam, the Netherlands 3 Rhodes University, Institute of Social and Economic Research (ISER), Grahamstown, South Africa.
Patient. 2010 Sep 1;3(3):159-72. doi: 10.2165/11531900-000000000-00000.
: Tuberculosis (TB) constitutes one-quarter of all avoidable deaths in developing countries. In the Eastern Cape, South Africa, TB is a public health problem of epidemic proportion. Poor compliance and frequent interruption to treatment are associated with increased transmission rates, morbidity, and costs to TB control programs. This study explored determinants of (non-)compliance from the patients' perspective.
: Semi-structured interviews were conducted with patients (33 treatment compliers and 34 treatment non-compliers) and 14 community health workers from local community clinics and the hospital in the township of Grahamstown, Eastern Cape, South Africa. Q-methodology was used. Patients rank ordered 32 opinion statements describing determinants of treatment compliance from the TB adherence model. By-person factor analysis was used to explore patterns in the rankings of statements by compliers and non-compliers. These patterns were interpreted and described as patient views on determinants of compliance with treatment. Patients and community health workers selected the top five determinants of compliance and non-compliance.
: Compliers believed that completing treatment would cure them of TB. Economic prospects were crucial for compliance. Compliers felt that the support of the government disability grant helped with compliance. Non-compliers believed that stigmatization had the greatest impact on non-compliance, together with the burden of disease, the arrangements involved with receiving treatment, restrictions accompanying treatment, and the association of TB with HIV/AIDS infection.
: Stigmatization makes TB a 'social disease'. Individual motivation and self-efficacy appear to have a considerable effect on compliance, but, for non-compliers, the general lack of job prospects and being able to provide for themselves or their family also makes TB very much an 'economic disease'.
结核病（TB）占发展中国家可避免死亡人数的四分之一。在南非东开普省，结核病是一种流行程度极高的公共卫生问题。治疗依从性差和经常中断治疗与传播率增加、发病率增加以及结核病控制项目成本增加有关。本研究从患者的角度探讨了不依从的决定因素。
在南非东开普省格雷厄姆斯敦镇的当地社区诊所和医院，对 33 名治疗依从者和 34 名治疗不依从者的患者以及 14 名社区卫生工作者进行了半结构化访谈。采用 Q 方法。患者对描述结核病依从性模型中治疗依从性决定因素的 32 个观点陈述进行了排序。通过个人因素分析，探讨了依从者和不依从者对陈述排序的模式。这些模式被解释并描述为患者对治疗依从性决定因素的看法。患者和社区卫生工作者选择了五个与治疗依从性和不依从性相关的最重要的决定因素。
依从者认为完成治疗将治愈他们的结核病。经济前景对依从性至关重要。依从者认为政府残疾津贴的支持有助于他们的依从性。不依从者认为污名化对不依从的影响最大，其次是疾病负担、接受治疗的安排、治疗伴随的限制以及结核病与艾滋病毒/艾滋病感染的关联。
污名化使结核病成为一种“社会疾病”。个人动机和自我效能似乎对依从性有相当大的影响，但对不依从者来说，缺乏工作前景和无法为自己或家人提供生活所需也使结核病成为一种“经济疾病”。
