Patient adherence to tuberculosis treatment : a systematic review of qualitative research
Date
2007-07-24
Journal Title
Journal ISSN
Volume Title
Publisher
Public Library of Science
Abstract
ENGLISH SUMMARY : Background
Tuberculosis (TB) is a major contributor to the global burden of disease and has received considerable attention in recent years, particularly in low- and middle-income countries where it is closely associated with HIV/AIDS. Poor adherence to treatment is common despite various
interventions aimed at improving treatment completion. Lack of a comprehensive and holistic
understanding of barriers to and facilitators of, treatment adherence is currently a major obstacle to finding effective solutions. The aim of this systematic review of qualitative studies was to understand the factors considered important by patients, caregivers and health care providers in contributing to TB medication adherence.
Methods and Findings
We searched 19 electronic databases (1966–February 2005) for qualitative studies on
patients’, caregivers’, or health care providers’ perceptions of adherence to preventive or
curative TB treatment with the free text terms ‘‘Tuberculosis AND (adherence OR compliance
OR concordance)’’. We supplemented our search with citation searches and by consulting
experts. For included studies, study quality was assessed using a predetermined checklist and
data were extracted independently onto a standard form. We then followed Noblit and Hare’s
method of meta-ethnography to synthesize the findings, using both reciprocal translation and
line-of-argument synthesis. We screened 7,814 citations and selected 44 articles that met the
prespecified inclusion criteria. The synthesis offers an overview of qualitative evidence derived
from these multiple international studies. We identified eight major themes across the studies:
organisation of treatment and care; interpretations of illness and wellness; the financial burden
of treatment; knowledge, attitudes, and beliefs about treatment; law and immigration; personal
characteristics and adherence behaviour; side effects; and family, community, and household
support. Our interpretation of the themes across all studies produced a line-of-argument
synthesis describing how four major factors interact to affect adherence to TB treatment:
structural factors, including poverty and gender discrimination; the social context; health
service factors; and personal factors. The findings of this study are limited by the quality and
foci of the included studies.
Conclusions
Adherence to the long course of TB treatment is a complex, dynamic phenomenon with a
wide range of factors impacting on treatment-taking behaviour. Patients’ adherence to their
medication regimens was influenced by the interaction of a number of these factors. The
findings of our review could help inform the development of patient-centred interventions and
of interventions to address structural barriers to treatment adherence.
Description
CITATION: Munro, S., et al. 2007. Patient adherence to tuberculosis treatment : a systematic review of qualitative research. PLoS Medicine, 4(7):1230-1245, doi: 10.1371/journal.pmed.0040238.
The original publication is available at http://journals.plos.org/plosmedicine
The original publication is available at http://journals.plos.org/plosmedicine
Keywords
Patient compliance -- Developing countries, Patient compliance -- Developing countries, Qualitative research -- Developing countries, Systematic reviews (Medical research)
Citation
Munro, S., et al. 2007. Patient adherence to tuberculosis treatment : a systematic review of qualitative research. PLoS Medicine, 4(7):1230-1245, doi: 10.1371/journal.pmed.
0040238