Tuberculosis Medication Nonadherence—A Qualitative Case Study

Abstract

India is grappling with the problem of controlling tuberculosis nearly for the past 50 years. The problem of nonadherence to treatment regimen has also worsened the situation of multidrug resistant tuberculosis (MDR-TB) in India. This article explores the factors behind nonadherence among erstwhile TB defaulters in a rural district in India. In-depth interviews with seven chronic defaulters and with healthcare professionals were conducted at a government-run Chest Clinic. In addition to in-depth interviews with defaulters and healthcare professionals, medical records and government orders related to TB control were examined extensively. Participants were also observed to understand their interaction with healthcare professionals and fellow patients, especially during drug delivery time. Qualitative content analysis is the most appropriate method to analyze the transcribed text and archival records. Qualitative content analysis brought out five major themes responsible for their past nonadherence behavior, namely, (a) Awareness about tuberculosis and treatment, (b) Symptom recognition and self-medication, (c) Family support, (d) Accessibility, and (e) Stigma. Findings are documented according to the major themes and documenting direct quotes from participants and with healthcare professionals wherever appropriate. This case study also provided context-specific recommendations to the healthcare professionals as regards the nonadherence behavior among TB patients. It is hoped these focused recommendations, albeit known to the healthcare professionals, would be extremely useful in making modifications to the existing program to tackle the nonadherence behavior.