</span><b><span style="font-family:Verdana;">Background:</span></b><span style="font-family:Verdana;"></b> The WHO recommended DOTS has been proven to be v...</span><b><span style="font-family:Verdana;">Background:</span></b><span style="font-family:Verdana;"></b> The WHO recommended DOTS has been proven to be very effective in the treatment of tuberculosis (TB) patients. However, despite its effectiveness, non-adherence to the treatment regimen remains a major concern in TB management. This has great consequences which include persistent infectiousness, higher rates of treatment failure, continued transmission, drug resistance, and untimely death. The aim of this study is to examine the factors and behavioural patterns that contribute to treatment adherence among TB patients in Kano State</span></span><span style="font-family:Verdana;">,</span> <span style="font-family:Verdana;">Nigeria</span><span style="font-family:""><span style="font-family:Verdana;">. <b></span><b><span style="font-family:Verdana;">Methods:</span></b><span style="font-family:Verdana;"></b></span><b><i> </i></b><span style="font-family:Verdana;">A qualitative study design which included two focus group discussions (FGDs) and four key informant interviews (KIIs) were adopted for this study. In total, 20 participants were interviewed comprising 16 focus group discussion participants (8 patients on treatment and 8 individuals who have been cured) divided into two groups and four key informant interviews with 4 health workers in the selected treatment facilities. Data analysis was done by translating and transcribing the responses from the FGDs and KIIs. The transcribed data was analysed using a thematic framework procedure. <b></span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"></b></span><b><i> </i></b><span style="font-family:Verdana;">It was observed that having a good treatment supporter who was effective and very supportive was the most important factor contributing to treatment adherence. Other identified factors that contributed to treatment adherence included: good communication by health personnel, social support from relatives and communities, little or no side effects from drug usage, low cost of transportation to the health facilities, a positive mind set towards drug usage and treatment, support and motivation from health workers, feelings of wellness during treatment, and a balanced diet. All the respondents agreed that treatment adherence had far reaching effects on positive treatment outcomes. </span><b><span style="font-family:Verdana;">Conclusion:</span><i> </i></b><span style="font-family:Verdana;">For better treatment adherence, a competent treatment supporter should be available for TB patients. Health care workers should ensure that effective </span><span style="font-family:Verdana;">communication and a cordial relationship do exist with TB patients. Also, TB patients should be properly counselled before the commencement of their treatment regimen to help them maintain a positive mind-set towards treatment. Finally, TB interventions should provide adequate social support for</span><span style="font-family:Verdana;"> patients.展开更多
Background: Treatment non-adherence poses significant risks to health outcomes and impedes the health system’s efficiency, hence curtailing progress towards the end Tuberculosis (TB) strategy under SDG 3.3. Despite i...Background: Treatment non-adherence poses significant risks to health outcomes and impedes the health system’s efficiency, hence curtailing progress towards the end Tuberculosis (TB) strategy under SDG 3.3. Despite interventions to address TB treatment non-adherence, Kenya still reports high TB treatment non-adherence rates of 35% and consequently poor treatment outcome rates. Health Care Workers (HCWs) play a critical role in linking the population to health services, yet little is known of their influence on patients’ TB treatment non-adherence in Kenya. Objective: To analyze HCW-related factors associated with TB treatment non-adherence among patients in Kisumu East Sub-County. Methods: Health facility-based analytical cross-sectional mixed-method study. A Semi-structured questionnaire on treatment adherence and patients’ perceptions of HCWs during the clinic visit was administered to 102 consenting adult (out of a total census of 107 adults) drug-susceptible TB patients. 12 purposively selected HCWs by rank from 6 health facilities participated in Key Informant Interview sessions. Medication adherence was measured using the Morisky Medication Adherence Scale and then expressed as a dichotomous variable. Quantitative analysis utilized STATA version 15.1 while qualitative deductive thematic analysis was done using NVIVO version 14. Results: TB treatment non-adherence rate of 26% (CI: 18% - 36%) was recorded. Overall, patients who felt supported in dealing with the illness were 8 times more likely to adhere to treatment compared to those who were not (aOR = 7.947, 95% CI: 2.214 - 28.527, p = 0.001). Key HCW related factors influencing adherence to treatment included: friendliness (cOR = 4.31, 95% CI: 1.514 - 12.284, p = 0.006), respect (cOR = 6.679, 95% CI: 2.239 - 19.923, p = 0.001) and non-discriminatory service (cOR = 0.1478, 95% CI: 0.047 - 0.464, p = 0.001), communication [adequacy of consultation time (cOR = 6.563, 95% CI: 2.467 - 17.458, p = 0.001) and patients’ involvement in their health decisions (cOR = 3.02 95% CI: 1.061 - 8.592, p = 0.038)] and education and counselling (cOR = 4.371, 95% CI: 1.725 - 11.075, p = 0.002). Conclusion: The study results underline importance of patient-centered consultation for TB patients and targeted education and counselling for improved treatment adherence.展开更多
Background:Patients’beliefs are a major factor affecting tuberculosis(TB)treatment adherence.However,there has been little use of Health Belief Model(HBM)in determining the pathway effect of patients’sociodemographi...Background:Patients’beliefs are a major factor affecting tuberculosis(TB)treatment adherence.However,there has been little use of Health Belief Model(HBM)in determining the pathway effect of patients’sociodemographic characteristics and beliefs on TB treatment adherence.Therefore,this study was aimed at determining the effect of sociodemographic characteristics and patients’health beliefs on TB treatment adherence based on the HBM concept in Ethiopia.Methods:A cross-sectional study was conducted in Addis Ababa,Ethiopia among TB patients undertaking treatment.Thirty health centres were randomly selected and one hospital was purposely chosen.Six hundred and ninety-eight TB patients who had been on treatment for 1-2 month,were aged 18 years or above,and had the mental capability to provide consent were enrolled consecutively with non-probability sampling technique from the TB registration book until required sample size achieved.Structured questionnaires were used to collect data.Structural equation modelling was employed to assess the pathway relationship between sociodemographic characteristics,patients’beliefs,and treatment adherence.Results:Of the 698 enrolled participants,401(57.4%)were male and 490(70.2%)were aged 35 years and below.The mean age of participants was 32(±11.7)and the age range was 18-90 years.Perceived barrier/benefit was shown to be a significant direct negative effect on TB treatment adherence(ß=−0.124,P=0.032).In addition,cue to action(ß=−0.68,P≤0.001)and psychological distress(ß=0.08,P<0.001)were shown significant indirect effects on TB treatment adherence through perceived barrier/benefit.Conclusions:Interventions intended to decrease perceived barriers and maximize perceived benefits should be implemented to enhance TB treatment adherence.In addition,it is crucial that counselling is incorporated with the regular directly observed therapy program.Motivators(cue to actions)such as friends,family,healthcare workers,and the media could be used to promote TB treatment adherence.展开更多
Aim:Treatment non-adherence is a common problem in patients suffering from schizophrenia and depression.This study investigated the possible relationships between symptom severity,quality of sleep,and treatment adhere...Aim:Treatment non-adherence is a common problem in patients suffering from schizophrenia and depression.This study investigated the possible relationships between symptom severity,quality of sleep,and treatment adherence.Methods:Thirty outpatients with schizophrenia and 58 outpatients with depression were enrolled in this study.The beck depression Inventory-II,the positive and negative syndrome scale,and the pittsburgh sleep quality index were used to assess symptom severity and quality of sleep,and sleep log data were used to measure treatment adherence.Results:The preliminary results showed no significant relationship between symptom severity and treatment adherence or between quality of sleep and treatment adherence in patients with depression.However,a significant positive relationship was found between negative symptoms and treatment adherence and a significant negative relationship between quality of sleep and treatment adherence in patients with schizophrenia.Conclusion:The present exploratory study revealed a positive relationship between symptom severity and treatment adherence and a negative relationship between quality of sleep and treatment adherence in patients with schizophrenia,but no significant relationships in patients with depression were found.Future studies are needed in order to gain a better understanding of possible risk factors related to treatment non-adherence.展开更多
The inflammatory bowel diseases(IBD) are chronicincurable inflammatory disorders of the gut. Some 10% run a downhill course, requiring emergency medical support and often surgery; another small subset are monogenic, a...The inflammatory bowel diseases(IBD) are chronicincurable inflammatory disorders of the gut. Some 10% run a downhill course, requiring emergency medical support and often surgery; another small subset are monogenic, and, threatening pediatric patients, are the challenge of these days. The majority of the IBDs, however, are polygenic low-penetrance diseases, running a lifetime waxing-and-waning course. The prevalent trend is towards a slow worsening and steady cost increase. Each and all drugs of the available arsenal exhibit strengths and weaknesses: Mesalamines are chiefly effectively for mildmoderate colitis, and do not work in Crohn's; steroids do not control some 40% of the ulcerative colitis cases, and are not indicated for Crohn's; thiopurines are effective in the maintenance of the IBDs but do not prevent relapses on withdrawal; biologics are still being used empirically(not monitored) causing further increase of their cost over that of hospitalization. Against all these caveats, two simple rules still hold true: Strict adherence maintenance and avoidance of colitogenic drugs. This matter is expanded in this minireview.展开更多
文摘</span><b><span style="font-family:Verdana;">Background:</span></b><span style="font-family:Verdana;"></b> The WHO recommended DOTS has been proven to be very effective in the treatment of tuberculosis (TB) patients. However, despite its effectiveness, non-adherence to the treatment regimen remains a major concern in TB management. This has great consequences which include persistent infectiousness, higher rates of treatment failure, continued transmission, drug resistance, and untimely death. The aim of this study is to examine the factors and behavioural patterns that contribute to treatment adherence among TB patients in Kano State</span></span><span style="font-family:Verdana;">,</span> <span style="font-family:Verdana;">Nigeria</span><span style="font-family:""><span style="font-family:Verdana;">. <b></span><b><span style="font-family:Verdana;">Methods:</span></b><span style="font-family:Verdana;"></b></span><b><i> </i></b><span style="font-family:Verdana;">A qualitative study design which included two focus group discussions (FGDs) and four key informant interviews (KIIs) were adopted for this study. In total, 20 participants were interviewed comprising 16 focus group discussion participants (8 patients on treatment and 8 individuals who have been cured) divided into two groups and four key informant interviews with 4 health workers in the selected treatment facilities. Data analysis was done by translating and transcribing the responses from the FGDs and KIIs. The transcribed data was analysed using a thematic framework procedure. <b></span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"></b></span><b><i> </i></b><span style="font-family:Verdana;">It was observed that having a good treatment supporter who was effective and very supportive was the most important factor contributing to treatment adherence. Other identified factors that contributed to treatment adherence included: good communication by health personnel, social support from relatives and communities, little or no side effects from drug usage, low cost of transportation to the health facilities, a positive mind set towards drug usage and treatment, support and motivation from health workers, feelings of wellness during treatment, and a balanced diet. All the respondents agreed that treatment adherence had far reaching effects on positive treatment outcomes. </span><b><span style="font-family:Verdana;">Conclusion:</span><i> </i></b><span style="font-family:Verdana;">For better treatment adherence, a competent treatment supporter should be available for TB patients. Health care workers should ensure that effective </span><span style="font-family:Verdana;">communication and a cordial relationship do exist with TB patients. Also, TB patients should be properly counselled before the commencement of their treatment regimen to help them maintain a positive mind-set towards treatment. Finally, TB interventions should provide adequate social support for</span><span style="font-family:Verdana;"> patients.
文摘Background: Treatment non-adherence poses significant risks to health outcomes and impedes the health system’s efficiency, hence curtailing progress towards the end Tuberculosis (TB) strategy under SDG 3.3. Despite interventions to address TB treatment non-adherence, Kenya still reports high TB treatment non-adherence rates of 35% and consequently poor treatment outcome rates. Health Care Workers (HCWs) play a critical role in linking the population to health services, yet little is known of their influence on patients’ TB treatment non-adherence in Kenya. Objective: To analyze HCW-related factors associated with TB treatment non-adherence among patients in Kisumu East Sub-County. Methods: Health facility-based analytical cross-sectional mixed-method study. A Semi-structured questionnaire on treatment adherence and patients’ perceptions of HCWs during the clinic visit was administered to 102 consenting adult (out of a total census of 107 adults) drug-susceptible TB patients. 12 purposively selected HCWs by rank from 6 health facilities participated in Key Informant Interview sessions. Medication adherence was measured using the Morisky Medication Adherence Scale and then expressed as a dichotomous variable. Quantitative analysis utilized STATA version 15.1 while qualitative deductive thematic analysis was done using NVIVO version 14. Results: TB treatment non-adherence rate of 26% (CI: 18% - 36%) was recorded. Overall, patients who felt supported in dealing with the illness were 8 times more likely to adhere to treatment compared to those who were not (aOR = 7.947, 95% CI: 2.214 - 28.527, p = 0.001). Key HCW related factors influencing adherence to treatment included: friendliness (cOR = 4.31, 95% CI: 1.514 - 12.284, p = 0.006), respect (cOR = 6.679, 95% CI: 2.239 - 19.923, p = 0.001) and non-discriminatory service (cOR = 0.1478, 95% CI: 0.047 - 0.464, p = 0.001), communication [adequacy of consultation time (cOR = 6.563, 95% CI: 2.467 - 17.458, p = 0.001) and patients’ involvement in their health decisions (cOR = 3.02 95% CI: 1.061 - 8.592, p = 0.038)] and education and counselling (cOR = 4.371, 95% CI: 1.725 - 11.075, p = 0.002). Conclusion: The study results underline importance of patient-centered consultation for TB patients and targeted education and counselling for improved treatment adherence.
基金This study was funded by the KNCV Tuberculosis FoundationUSAID/TB CARE I+1 种基金Tehran University of Medical Sciences,International Campusand the Ethiopian Public Health Institute.
文摘Background:Patients’beliefs are a major factor affecting tuberculosis(TB)treatment adherence.However,there has been little use of Health Belief Model(HBM)in determining the pathway effect of patients’sociodemographic characteristics and beliefs on TB treatment adherence.Therefore,this study was aimed at determining the effect of sociodemographic characteristics and patients’health beliefs on TB treatment adherence based on the HBM concept in Ethiopia.Methods:A cross-sectional study was conducted in Addis Ababa,Ethiopia among TB patients undertaking treatment.Thirty health centres were randomly selected and one hospital was purposely chosen.Six hundred and ninety-eight TB patients who had been on treatment for 1-2 month,were aged 18 years or above,and had the mental capability to provide consent were enrolled consecutively with non-probability sampling technique from the TB registration book until required sample size achieved.Structured questionnaires were used to collect data.Structural equation modelling was employed to assess the pathway relationship between sociodemographic characteristics,patients’beliefs,and treatment adherence.Results:Of the 698 enrolled participants,401(57.4%)were male and 490(70.2%)were aged 35 years and below.The mean age of participants was 32(±11.7)and the age range was 18-90 years.Perceived barrier/benefit was shown to be a significant direct negative effect on TB treatment adherence(ß=−0.124,P=0.032).In addition,cue to action(ß=−0.68,P≤0.001)and psychological distress(ß=0.08,P<0.001)were shown significant indirect effects on TB treatment adherence through perceived barrier/benefit.Conclusions:Interventions intended to decrease perceived barriers and maximize perceived benefits should be implemented to enhance TB treatment adherence.In addition,it is crucial that counselling is incorporated with the regular directly observed therapy program.Motivators(cue to actions)such as friends,family,healthcare workers,and the media could be used to promote TB treatment adherence.
文摘Aim:Treatment non-adherence is a common problem in patients suffering from schizophrenia and depression.This study investigated the possible relationships between symptom severity,quality of sleep,and treatment adherence.Methods:Thirty outpatients with schizophrenia and 58 outpatients with depression were enrolled in this study.The beck depression Inventory-II,the positive and negative syndrome scale,and the pittsburgh sleep quality index were used to assess symptom severity and quality of sleep,and sleep log data were used to measure treatment adherence.Results:The preliminary results showed no significant relationship between symptom severity and treatment adherence or between quality of sleep and treatment adherence in patients with depression.However,a significant positive relationship was found between negative symptoms and treatment adherence and a significant negative relationship between quality of sleep and treatment adherence in patients with schizophrenia.Conclusion:The present exploratory study revealed a positive relationship between symptom severity and treatment adherence and a negative relationship between quality of sleep and treatment adherence in patients with schizophrenia,but no significant relationships in patients with depression were found.Future studies are needed in order to gain a better understanding of possible risk factors related to treatment non-adherence.
文摘The inflammatory bowel diseases(IBD) are chronicincurable inflammatory disorders of the gut. Some 10% run a downhill course, requiring emergency medical support and often surgery; another small subset are monogenic, and, threatening pediatric patients, are the challenge of these days. The majority of the IBDs, however, are polygenic low-penetrance diseases, running a lifetime waxing-and-waning course. The prevalent trend is towards a slow worsening and steady cost increase. Each and all drugs of the available arsenal exhibit strengths and weaknesses: Mesalamines are chiefly effectively for mildmoderate colitis, and do not work in Crohn's; steroids do not control some 40% of the ulcerative colitis cases, and are not indicated for Crohn's; thiopurines are effective in the maintenance of the IBDs but do not prevent relapses on withdrawal; biologics are still being used empirically(not monitored) causing further increase of their cost over that of hospitalization. Against all these caveats, two simple rules still hold true: Strict adherence maintenance and avoidance of colitogenic drugs. This matter is expanded in this minireview.
