Gebreweld Frezghi Hidray, Kifle Meron Mehari, Gebremicheal Fitusm Eyob, Simel Leban Lebahati, Gezae Meron Mebrahtu, Ghebreyesus Shewit Sibhatu, Mengsteab Yordanos Tesfamariam, Wahd Nebiat Ghirmay
Ministry of Health, Asmara, Eritrea.
Department of Epidemiology and Biostatistics, School of Public Health, Asmara College of Health Sciences, Asmara, Eritrea.
J Health Popul Nutr. 2018 Jan 5;37(1):1. doi: 10.1186/s41043-017-0132-y.
Non-adherence to tuberculosis (TB) treatment is an important barrier for TB prevention and control. Poor adherence may result in prolonged disease infectiousness, drug resistance, relapse and death. The aim of this study was to assess factors influencing adherence to tuberculosis treatment in selected health facilities in Asmara, Eritrea.
A qualitative study which included in-depth interviews with 12 TB patients, three focus group discussions in selected health facilities in which one group comprised eight patients and key informant interviews with three health workers. Data analysis was done by translating and transcribing the verbatim of the interviews and focus group discussions. Transcribed data was then analysed using thematic framework procedure.
This study found that patients lacked knowledge about the cause, transmission and duration of treatment of TB. The most common reason mentioned for discontinuing treatment was the patient "felt cured". Almost half of the respondents did not know the standard treatment duration and the consequences they face if they halt treatment. Patients reported losing their job when their diagnosis was known, were too ill to continue working or unable to find daily work due to time-consuming treatment arrangements. With few exceptions, the majority of patients reported that the short distance to the clinic encouraged them to attend regular treatment follow-up. Most of the respondents were unable to get enough food, leading to stress and feelings of hopelessness. Lack of social support for most of the patients was a critical factor for adherence as were stigma, medication side effects and long treatment duration. Recognized as an enabler to treatment adherence, health workers had good communication and positive attitude towards their patients.
Lack of knowledge, loss of income, stigma and lack of social support, drug side effects and long treatment duration emerged as important barriers for treatment adherence. Short distances to health facilities, good communication and accepting attitude of health care providers emerged as enablers for treatment adherence. For better treatment adherence, comprehensive health education at treatment sites, patient's family members and the community at large and strengthening of social support structures need to be addressed.
不坚持结核病治疗是结核病预防与控制的一个重要障碍。依从性差可能导致疾病传染性延长、耐药、复发及死亡。本研究的目的是评估影响厄立特里亚阿斯马拉部分医疗机构结核病治疗依从性的因素。
一项定性研究，包括对12名结核病患者进行深入访谈、在部分医疗机构开展三场焦点小组讨论（其中一组有8名患者）以及对三名医护人员进行关键 informant 访谈。通过对访谈和焦点小组讨论的逐字记录进行翻译和转录来进行数据分析。然后使用主题框架程序对转录数据进行分析。
本研究发现患者对结核病的病因、传播及治疗持续时间缺乏了解。提到的中断治疗最常见原因是患者“感觉已治愈”。近一半的受访者不知道标准治疗持续时间以及中断治疗会面临的后果。患者报告称，当他们的诊断被知晓后会失去工作，病得太重无法继续工作，或者由于耗时的治疗安排而无法找到日常工作。除少数例外，大多数患者报告称到诊所的距离短促使他们定期接受治疗随访。大多数受访者无法获得足够食物，导致压力和绝望感。对大多数患者来说，缺乏社会支持是依从性的一个关键因素，耻辱感、药物副作用和治疗持续时间长也是如此。医护人员被认为是治疗依从性的促进因素，他们与患者沟通良好且态度积极。
知识缺乏、收入损失、耻辱感、缺乏社会支持、药物副作用和治疗持续时间长成为治疗依从性的重要障碍。到医疗机构距离短、医护人员良好的沟通和接纳态度成为治疗依从性的促进因素。为了提高治疗依从性，需要在治疗场所、患者家属及广大社区开展全面的健康教育，并加强社会支持结构。
