b) Measures to Improve Treatment Adherence
AU : Ngodup
TI : Patient-provider interaction in the community based case management of tuberculosis in the urban district of Bangalore city, south India
SO : A thesis submitted by Dr Ngodup, Postgraduate student, as a part of his PG course on “Community health and health management in developing countries” of the University of Heidelberg, Germany (1998)
DT : M
AB :

Non-adherence to treatment is an obstacle to the control of TB. Among many reasons mentioned for non-adherence, providers’ attitude, behaviour and knowledge and skill in dealing with TB patients has been cited as an important factor. Few studies also indicate that communication between patient and provider during interaction also plays an important role in the therapeutic process. Hence, this present study on patient-provider interaction was designed to describe some of the factors affecting adherence to TB treatment at LWTDTC, at urban district of Bangalore and its catchment area. The main objectives of the study were to find out the rate of adherence, application of present national control programme, patient perception of DOTS, retrospective elucidation of patient provider interaction and its influence on adherence to treatment. Treatment cards of a total of 602 smear positive patients treated with SCC regimen during Jan to Sept 1997 were analysed. From among them, 11 completed patients and 13 non-adherent patients were selected by systematic random sampling for subsequent interviewing. Further, 10 patients out of 153 patients who were under treatment from April to May 1998 and 15 patients receiving DOTS from 4 Treatment Units were selected by purposive sampling for the interviews. In addition, 23 health care providers (physicians, nurses, health visitors, laboratory technicians and health workers) were interviewed.

Most of the patients interviewed have sought the help of private health services prior to their diagnosis with the belief that their illness is not severe and attributed to cold, fever and viral infections. A majority of the patients were diagnosed within four weeks at the place of treatment. Only some had delay of more than 4 weeks. They were either referred by the initial provider (majority) or by self-motivation. Of the 602 patients, 449 (74.5%) did not complete the treatment. The non-adherence was more significant in the age group of 21-40 years. Defaulting was higher among males than females. The defaulting was early, as 64.3% defaulted within three months. None of the non-adherent patients reported having received a letter or being personally contacted by the staff. The patients put on DOTS had a separate box of anti-TB drugs for him/her and were given drugs in the intensive phase three times a week under direct observation and once a week in the continuation phase and two doses for self-administration. The results were that 74.2% of the patients put on DOTS were cured at the end of treatment. The providers have strong belief that DOTS is the answer to the problem of low adherence.

The most common reasons given for non-adherence by patients, providers and key informants, were lack of family support, providers behaviour, drug side effect, disappearance of symptoms, alcohol and smoking. Adherent patients attributed family support, self-motivation and providers’ assurance as motivating factors for completion of the treatment.


Traditional Birth Attendents (DAIS) as DOT providers