Centre of Quality Management of Medicines, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300 Kuala Lumpur, Malaysia.
Department of Pharmacy, Sarawak General Hospital, Ministry of Health Malaysia, Jalan Tun Ahmad Zaidi Adruce, 93586 Kuching, Sarawak, Malaysia.
Health Promot Int. 2024 Dec 1;39(6). doi: 10.1093/heapro/daae176.
Tuberculosis (TB) treatment interruption undermines the effectiveness of TB medications and jeopardizes treatment outcomes. This study aimed to explore barriers, challenges, coping strategies and facilitators of TB treatment interruption to understand the treatment pathway in achieving successful outcomes. In-depth interviews were conducted at public health clinics in Sarawak, Malaysia, utilizing a phenomenological approach. Thirty patients who experienced TB treatment interruption with eventual successful treatment were purposively selected based on various reasons for treatment interruption to obtain diverse viewpoints. The audio-recorded transcriptions underwent thematic and content analysis. Five major themes emerged under barriers and challenges: socioeconomic, patient, therapy, healthcare and condition-related factors. Notably, financial burdens led individuals to prioritize work over health. Adverse drug reactions resulted in inappropriate self-medication and healthcare dissatisfaction. Medication error with suboptimal dosing was another facet leading to treatment forfeiture. Lack of knowledge about treatment duration and medication adherence, along with negative personal factors such as laziness, dishonesty and forgetfulness were reported. Participants employed coping strategies to confront barriers and challenges, including acceptance and commitment to disease and treatment, self-adaptation in mental, physical and social aspects, and self-management of minor adverse events. Fear of disease worsening, previous experiences, social and financial supports, along with intrinsic motivators, were essential facilitators that prevented interruptions. Interconnectivity across the explored dimensions contextualized the understanding of TB treatment interruption and offered valuable information for designing patient-centered intervention strategies. Improving patient education coupled with tailored interventions addressing psychosocial and economic barriers is crucial for ensuring TB treatment completion.
肺结核（TB）治疗中断会降低抗结核药物的疗效，并危及治疗结果。本研究旨在探讨肺结核治疗中断的障碍、挑战、应对策略和促进因素，以了解实现成功治疗结局的治疗途径。本研究在马来西亚砂拉越的公共卫生诊所采用现象学方法进行深入访谈。根据治疗中断的各种原因，有 30 名经历过肺结核治疗中断但最终成功治疗的患者被有目的地选择参与，以获得不同的观点。对录音转录进行了主题和内容分析。在障碍和挑战下出现了五个主要主题：社会经济、患者、治疗、医疗保健和病情相关因素。值得注意的是，经济负担迫使个人优先考虑工作而不是健康。药物不良反应导致不适当的自我用药和对医疗保健的不满。用药错误导致剂量不足是导致治疗失败的另一个因素。缺乏对治疗持续时间和药物依从性的了解，以及诸如懒惰、不诚实和健忘等负面个人因素也有报道。参与者采用应对策略来应对障碍和挑战，包括对疾病和治疗的接受和承诺、心理、身体和社会方面的自我适应，以及对轻微不良事件的自我管理。对疾病恶化、以往经验、社会和经济支持以及内在动机的恐惧是防止中断的重要促进因素。探索到的各个维度之间的相互联系使我们能够更好地理解肺结核治疗中断，并为设计以患者为中心的干预策略提供了有价值的信息。改善患者教育，并针对社会心理和经济障碍制定量身定制的干预措施，对于确保结核病治疗的完成至关重要。
