b) Socio-Cultural, Socio-Economic & Demographic Aspects
AU : Hartz J
TI : Human relationships in tuberculosis.
SO : PUBLIC HEALTH REP 1950, 65, 1292-1301.
DT : Per
AB :

This paper reviews some common attitudes towards TB, their sources and, offers suggestions for their management. It is suggested that the whole topic of human relationships needs to be studied and considered in relation to the problem of control of TB. Patients arrive at the sanatorium with some degree of emotional disturbance. Where morale is good and careful thought is given to the range of human personality reactions, most patients will adjust satisfactorily and respond as expected to treatment. However, a large majority can be expected to encounter serious difficulties during or after their hospitalisation, mainly because of emotional disturbances. These disturbances cannot always be avoided, but usually their occurrence can be foreseen and their seriousness modified if there has been an adequate personality investigation early in the patient's stay. Likewise, intelligent planning to cope with the social and rehabilitation problems of the patient will go forward much more realistically from such a base. Certainly, in terms of practical management, pulmonary TB can be as much a disease of the personality as it is of the lungs.


AU : San Sebastian M & Bothamley GH
TI : Tuberculosis preventive therapy: perspective from a multi-ethnic community
SO : RESPIRATORY MEDICINE 2000, 94, 648-653
DT : Per
AB :

A study was undertaken to explore the knowledge, attitudes and perception of TB and their influence on the adherence to preventive therapy for TB. During 1997, 24 subjects were interviewed by using a semistructured questionnaire which included demographic details, background information on TB, knowledge and perception of TB and chemoprophylaxis. The persons were interviewed in the outpatient clinic in London at the start of the treatment and at monthly intervals thereafter. They were given INH daily for 6 months. The data was analysed descriptively and thematically. The outcome was assessed ? 6 months after the start of preventive treatment.

The sample was representative of age, ethnicity and previous BCG vaccination status. The study results revealed that 63% were aware of TB before starting chemoprophylaxis indicating a medium level of awareness. None mentioned health centre as the source of information. Knowledge of TB was gained outside the family. About 63% of them knew about transmission of the disease but few symptoms of active TB were recognized. Most (92%) were aware that TB was infectious. The perceived threat from TB was high (71% believed that TB was potentially fatal), although the estimated risk was low. Over half of the subjects (66.6%) suggested that TB was preventable. Knowledge of preventive therapy exceeded the general knowledge of TB, although the latter was associated with better adherence. Most denied knowledge of the risk of hepatitis from isoniazid. Defaulters failed to attend their first appointment, attributed more side effects to isoniazid and perceived a longer waiting time in clinic. The rate of non-attendance for appointment at the TB clinic was high.

The study has shown that there is an important lack of knowledge of the symptoms of TB. A better general knowledge of TB is more helpful than merely an understanding of the treatment regimen in promoting adherence. It recommends a single daily tablet, prior warning of dizziness and an open discussion of the problems of keeping to treatment for 6 months encouraging adherence to preventive treatment.


  c) Behavioural And Psychological Factors  
AU : Calden G
TI : A method for evaluating the attitudes of tuberculous patients.
SO : AME REV RESPIR DIS 1953, 67, 722-731.
DT : Per
AB :

Those attitudes and emotional reactions of patients which interfere with medical treatment, for instance, patients who suddenly leave the hospital against medical advice, obstinate patients who refuse to accept the diagnosis of TB and refuse medication, could be lessened considerably if the patients' attitudes are recognized and dealt with early in hospitalization. To this end, an attitude form which could be incorporated readily in routine hospital procedures was developed at the Veterans Administration Hospital in Madison, Wisconsin, USA and administered to more than 200 TB patients.

The form aided in evaluating the attitudes and emotional reactions of TB patients in nine significant areas of adjustment. Patients expressed their attitudes and feelings to: (1) Bed rest, (2) Hospitalization, (3) TB, (4) Ward life, (5) The medical staff, (6) Irregular discharge, (7) Family and friends, (8) Medical treatment, (9) Attitudes of a general nature, by completing a series of 80 incomplete sentences.

A preliminary survey of the results indicated that the form promised to be a highly effective means of obtaining the patients' attitudes and thus, assist in dealing with the patients' adjustment to his/ her disease and hospitalization.


a) Community Survey Based
AU : Geetakrishnan K, Pappu KP & Roychowdhury K
TI : A study on knowledge and attitude towards tuberculosis in a rural area of West Bengal.
SO : INDIAN J TB 1988, 35, 83-89.
DT : Per
AB :

A survey was carried out in the population of Bisnupur Blocks I and II in the south 24 parganas district of West Bengal to find out the level of general knowledge and awareness about TB and also the prevalent social attitudes towards the disease. The target population was classified into two broad groups comprising persons living within and outside the research project area respectively. The results showed that the general knowledge of TB was high in both groups and about 24% of the new patients did not know the correct duration of treatment. The majority of people interviewed, favored hospitalization of the TB patients and the patients' belief that consuming anti-TB drugs without taking a high protein diet was futile contributed to default on drug collection. Women with TB denied breast-milk to their babies, making the babies vulnerable to different diseases including TB. Health education increased the awareness of TB while negative social attitudes for TB patients persisted because most people were not convinced of the curability of the disease.

The above findings led to the conclusion that community leaders should be actively involved in any TB control programme and that health education should be an important component of the TB programme.


TI : Awareness of tuberculosis: Editorial.
SO : INDIAN J TB 1989, 36, 69-70.
DT : Per
AB :

The inquiry into people's awareness of TB has largely followed two schools of thought. The earlier conception about the awareness of TB was centered on the extent of people's knowledge about the disease and its characteristics, how the infection spread, when and where it typically occurred etc. However, several studies such as the one conducted by the NTI in rural Anantapur district in the late '50s and which led to the formulation of the DTP, demonstrated that, in contrast to the hypothesis, knowledge about the main features of TB was quite high. Other, more recent studies conducted in India and, studies from S. Korea and Japan, where socio-economic conditions are very different, obtained similar results.

The second, more recent approach to awareness focussed on physical suffering caused by the symptoms of TB. This approach was highlighted by the series of NTI studies beginning with their seminal 1963 study titled, "A sociological study of awareness of symptoms among persons with pulmonary TB". Based on the results, it was suggested that awareness of symptoms and action-taking, by way of contacting institutions of modern medicine, be used as parameters for measuring the problem of TB in the community, sociologically and for TB programme assessment. Further, it was emphasized that this approach must be pursued vigorously through action research as it appeared to show great promise in breaking down the barriers of traditional thinking, prejudices and unhelpful attitudes better and more quickly.


  b) Health Centre Based  
AU : Radha Narayan
TI : Long term sociological follow up of symptom recurrence and action taken by tuberculosis patients.
SO : INDIAN J PREV & SOC MED 1978, 9, 85-91.
DT : Per
AB :

A long term follow up study of symptom recurrence and action taking of TB patients of urban clinics in metropolitan cities may be of limited value. But such follow up studies based on a PHC, which is an important rural diagnostic and treatment unit in the TB programmes will be of a great value, because the center is responsible for comprehensive preventive and curative services to the community through family and household units. It is, therefore, important to know whether a TB patient, diagnosed and put on treatment by the centre, experiences recurrence of the symptom, for which he has sought relief at the centre and if so whether he goes in search of relief elsewhere.


b) Measures to Improve Treatment Adherence
AU : Nagpaul DR
TI : Holistic health education: Editorial.
SO : INDIAN J TB 1993, 40, 107-108.
DT : Per
AB :

The author emphasises the need to take a holistic approach to health education. In India, changes in the curricula of medical colleges have not gone far enough to change the prevalent focus on disease and the attitudes and practices that go with it. Some pragmatic social scientists have recognized that health education is needed, not only for the general public, but for health administrators and teachers of TB and chest diseases too, in order to change their behaviour. Therefore, they suggest that to generate additional felt need among the people, health education is needed only when the existing felt needs of the people have been met and there is surplus capacity left to meet the extra needs. This, then, is the need-based cutting edge of health education.