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dc.contributor.authorMunro, Salla Anb_NO
dc.contributor.authorLewin, Simon Anb_NO
dc.contributor.authorSmith, Helen Jnb_NO
dc.contributor.authorEngel, Mark Enb_NO
dc.contributor.authorFretheim, Atlenb_NO
dc.contributor.authorVolmink, Jimmynb_NO
dc.date.accessioned2008-05-10T20:32:21Znb_NO
dc.date.accessioned2016-02-08T14:18:08Z
dc.date.available2008-05-10T20:32:21Znb_NO
dc.date.available2016-02-08T14:18:08Z
dc.date.issued2007-07-24nb_NO
dc.identifier.citationPLoS medicine 2007, 4 (7):e238en
dc.identifier.issn1549-1676nb_NO
dc.identifier.urihttp://hdl.handle.net/11250/2377405
dc.description.abstractBACKGROUND: 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.en
dc.language.isoengen
dc.subjectVDP::Medisinske Fag: 700en
dc.subjectVDP::Medisinske Fag: 700::Klinisk medisinske fag: 750::Infeksjonsmedisin: 776en
dc.subject.meshHumansen
dc.subject.meshOutcome Assessment (Health Care)en
dc.subject.meshPatient Complianceen
dc.subject.meshQualitative Researchen
dc.subject.meshTuberculosisen
dc.titlePatient adherence to tuberculosis treatment: a systematic review of qualitative research.en
dc.typeJournal articleen
dc.typePeer revieweden
dc.source.journalPLoS medicineen
dc.identifier.doi10.1371/journal.pmed.0040238nb_NO
dc.identifier.pmid17676945nb_NO
dc.contributor.departmentSouth African Cochrane Centre, Medical Research Council of South Africa, Cape Town, South Africa. salla.munro@mrc.ac.zaen


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