Ahuja Nirmal, Kuzmik Ashley, Sznajder Kristin, Lengerich Eugene, Fredrick N Benjamin, Chen Michael, Hwang Wenke, Patil Rajendra, Shaikh Bushra
School of Behavioral Sciences and Education, Penn State Harrisburg, Middletown, USA.
Penn State Ross and Carol Nese College of Nursing, Pennsylvania State University, State College, USA.
Cureus. 2024 Nov 26;16(11):e74507. doi: 10.7759/cureus.74507. eCollection 2024 Nov.
Introduction Despite efforts, tuberculosis (TB) remains a major public health problem in developing countries, and India alone accounts for most of the global TB cases. Although the treatment for TB is highly successful, a significant number of TB patients in India do not complete their assigned treatment. Social support has a key influence on medication adherence for chronic illnesses like diabetes, asthma, HIV, hypertension, cardiovascular diseases, and TB. However, limited research in India focuses on patients' perceived social support and its association with medication dose interruption among pulmonary TB patients. This study aims to fill this gap and examine the association between perceived social support and medication dose interruption among pulmonary TB patients in Western India. Methods A cross-sectional study was conducted at three directly observed treatment, short-course (DOTS) centers in Bhiwandi City, Maharashtra state, in Western India. A total of 477 participants were recruited, and data on participants' medication dose interruptions in the last month, their clinical characteristics, and their perceived social support were collected. Descriptive and inferential statistics were applied. Results Perceived social support presented a significant association with TB medication dose interruption. Participants who reported low social support were significantly 2.6 times more likely to miss their doses in the last month (adjusted odds ratio (aOR) = 2.6 (95% confidence interval (CI): 1.556-4.403), P < 0.001). Participants who reported low family support were significantly 4.1 times more likely to miss their doses when compared with the participants who reported high family support (aOR = 4.1 (95% CI: 2.482-7.070), P < 0.001). Among the participants who missed their doses one to five times in the last month, those who reported low social support were significantly 2.5 times more likely to miss their doses, when compared with the participants who reported high social support (aOR = 2.5 (95% CI: 1.318-4.810), P = 0.005). Likewise, among the group of participants who missed their doses six or more times in the last month, those who reported low social support were significantly 3.1 times more likely to miss their doses, when compared with the participants who reported high social support (aOR = 3.1 (95% CI: 1.452-6.744), P = 0.004). Conclusion The study results underscore the importance of integrating patient-centered strategies into healthcare systems, ensuring that they not only offer social protection but also recognize social support as a critical component of TB treatment. This study could potentially inform various healthcare policymakers in formulating such patient-centric and focused intervention strategies by involving social networks and family dynamics.
引言 尽管做出了诸多努力,但结核病在发展中国家仍是一个重大的公共卫生问题,仅印度就占全球结核病病例的大部分。虽然结核病治疗非常成功,但印度有相当数量的结核病患者未完成规定的治疗。社会支持对糖尿病、哮喘、艾滋病毒、高血压、心血管疾病和结核病等慢性病的药物依从性有关键影响。然而,印度的相关研究有限,主要关注肺结核患者对社会支持的感知及其与药物剂量中断的关联。本研究旨在填补这一空白,探讨印度西部肺结核患者的社会支持感知与药物剂量中断之间的关联。
方法 在印度西部马哈拉施特拉邦比万迪市的三个直接观察短程治疗(DOTS)中心进行了一项横断面研究。共招募了477名参与者,收集了他们上个月药物剂量中断情况、临床特征以及社会支持感知的数据。应用了描述性和推断性统计方法。
结果 社会支持感知与结核病药物剂量中断存在显著关联。报告社会支持低的参与者在上个月错过剂量的可能性显著高出2.6倍(调整后的优势比(aOR)=2.6(95%置信区间(CI):1.556 - 4.403),P < 0.001)。报告家庭支持低的参与者与报告家庭支持高的参与者相比,错过剂量的可能性显著高出4.1倍(aOR = 4.1(95%CI:2.482 - 7.070),P < 0.001)。在上个月错过剂量一至五次的参与者中,报告社会支持低的参与者与报告社会支持高的参与者相比,错过剂量的可能性显著高出2.5倍(aOR = 2.5(95%CI:1.318 - 4.810),P = 0.005)。同样,在上个月错过剂量六次或更多次的参与者组中,报告社会支持低的参与者与报告社会支持高的参与者相比,错过剂量的可能性显著高出3.1倍(aOR = 3.1(95%CI:1.452 - 6.744),P = 0.004)。
结论 研究结果强调了将以患者为中心的策略纳入医疗保健系统的重要性,确保这些系统不仅提供社会保护,还将社会支持视为结核病治疗的关键组成部分。本研究可能为各类医疗保健政策制定者提供参考,通过纳入社会网络和家庭动态来制定此类以患者为中心的针对性干预策略。