Literature Review Matrix Template Author/ Theoretical/ Date/ Sources Conceptual Framework H. Meulemans, D. The proposed Mortelmans, R.

model could Liefooghe, P. be described Mertens, as a two-step S. Akbar Zaidi, M. model. First, Farooq Solangi an explanation and A. De is sought for Muynck/2002/Int the ways in ernational which TB Journal Of Health patients are Planning And stigmatized. Management, The second Published online step in the in Wiley model is the InterScience causal (www.interscienc explanation of e.wiley.com). compliance DOI: (Burman et al., 10.1002/hpm.675 1997). The model THE LIMITS TO distinguishes PATIENT three factors. COMPLIANCE WITH DIRECTLY OBSERVED THERAPY FOR TUBERCULOSIS: A

Research Question(s)/ Hypotheses The basic hypothesis is that a decrease of support from a patients family will be associated with an increase in stigmatization.

Methodology

Analysis & Results The 621 patients were composed of 56.5% men and 43.5% women. Compliance has to be viewed not only from the social stratification perspective but also from the stigmatization perspective. At the onset of the treatment and after 2 months treatment seven statements concerning stigmatization (see Latent constructs) were presented to the patients. The statement most people (more than 80%) agreed with, both at the onset of the treatment and 2 months afterwards, was: If someone has TB, he/she avoids talking about it with other persons. If someone contracts TB it is best to keep quiet

Conclusions

The study is based on face-to-face interviews carried out at Bethania Hospital, amongst all sputum positive pulmonary TB patients (n621). The patients were interviewed at three fixed moments: at the start of the treatment, after 1 month, after 2 months and followed-up until the end of the treatment. Every interview was performed by a social worker belonging to a team of four.

Patient compliance with the DOT regimen is an essential condition for combating the tuberculosis epidemic both in countries with high and low levels of welfare. For TB patients, compliance means regularly taking different medicines for a long period of time under medical supervision. In the research, it established that compliance is thwarted by many conditions. Economic, demographical, geographical, psychological and socio-cultural

Implications for the current research The study shows that stigma is present in Pakistan and it affects the compliance of the patient in DOTS. It also shows that it disrupts the lives of the patients making them insecure. The study will help support the idea that social stigma affects the compliance to DOTS.

Implications For practice The research proves that in Pakistan, stigma exists and health care providers have to intervene to be able to clear the misconceptions about TB that causes stigma.

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SOCIO-MEDICAL STUDY IN PAKISTAN

about it. The statement only a minority (one out of four patients) agreed with, both at the onset of the treatment and after 2 months, was: It is difficult to earn your living after recovering from TB. The fact that only very few regarded their TB problem in terms of income is related to the fact that during this lifethreatening situation, the treatment has absolute priority and takes precedence over all other forms of need.

factors have an impact on illness behavior. Furthermore, not only the social stratification perspective, but also the stigmatization perspective increases insight into the mechanisms of rejection of norms and noncompliance of TB patients. TB patients are stigmatized because their illness disrupts their lives and causes insecurities. It threatens their social relations and social structure because their illness bears the hallmark of a subculture of poverty, weakness and lack of hygiene. This

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Aryal S,Badhu A,Pandey S, Bhandari A Khatiwoda P, Khatiwada P, Giri A/2012/KATHMA NDU UNIVERSITY MEDICAL JOURNAL, 2012;37(1)48-52.

To assess the stigma experienced by tuberculosis patients and to find out the association between stigma experienced by Tuberculosis patient and the selected variables (socio-demographic characteristics, clinical profile and illness experience).

STIGMA RELATED TO TUBERCULOSIS AMONG PATIENTS ATTENDING DOTS CLINICS OF DHARAN MUNICIPALITY

Descriptive Cross Sectional study was done among sixty tuberculosis patients. Stratified random sampling was used to select the main center and sub center of Tuberculosis treatment and population proportionate simple random sampling using lottery method was done. Data was collected using predesigned pretest perform from Explanatory Model Interview Catalogue developed by World Health Organization.

The study revealed that 63.3% of the subjects were stigmatized. There was association between stigma and variables such as occupation, monthly family income and past history of Tuberculosis. There was also association of stigma with treatment phase, category of the patient and past outcome of illness.

research has demonstrated that it is essential to permanently evaluate DOT and expose possible stigmatization effects. Due to lack of knowledge and awareness about Tuberculosis, many patients were stigmatized. Efforts should be made to educate the public about Tuberculosis to reduce stigma experienced by Tuberculosis patients and improve the compliance of the patient.

The research will provide a baseline on how stigma is present in TB patient. And on how stigma can greatly affect TB patients. The research implies that stigma has an effect on the patients selfesteem and most crucial, it affects the compliance of one patient.

The research will open the eyes of every health care provider that stigma among TB patients are rampant. Thus, immediate intervention must be given. The researcher suggests that there must be community awareness about the facts and myth about tuberculosis. One way to provide awareness is to educate not just the family or employer but the

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whole population on what TB is really is. V. K. Dhingra and Shadab Khan/2010/ [Indian J Tuberc 2010; 57:12-18] A SOCIOLOGICAL STUDY ON STIGMA AMONG TB PATIENTS IN DELHI To assess the effect of social stigma in TB patients treatment, their personality, emotions, feelings, changes in their thinking process and behavior of their family members, friends.To study the relationship of gender and to what extent social stigma affects their lives. It was a prospective study. A total of 1977 newly diagnosed and registered cases under Revised National TB Control Programme for treatment during the period of March 2009 to May 2009 was included in the study. Out of a total population of 170 lacs, a proportion of 31 lacs of Delhi, distributed among five chest clinics of Delhi, comprised the study population. All the patients were interviewed according to a pre-designed & pretested questionnaire after taking informed consent of the patients. The data was collected and analyzed after processing into MS excel sheets for statistical analysis. There was an immense stigma observed at society level with 60% of the patients hiding their disease (p<0.05) from friends and neighbors. Stigma was observed more among middle and upper middle class when compared to lower middle class and lower class (p<0.05). Genderwise further it was observed that stigma was more among females (p<0.05) than in males. The study has demonstrated that despite good performance of Revised National TB Control Programme, the stigma in tuberculosis still remains a problem and we need to supplement the efforts in advocacy, communication and social mobalization for reducing the stigma problem among TB patients in effective control of tuberculosis. It shows that 60% of the sample choose to hide their condition, it only suggest that stigma affects the diagnosis of TB and further lessen the success rate DOTS. The research shows that health care providers must act to eradicate the stigma that surrounds TB. It is a clear hindrance in the early diagnosis that will help to lessen the mortality rate of TB. Health care providers must be aware that patients are sensitive in dealing with their condition and an extra care must be given to them.

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Zacheus Matebesi* & Christiane Timmerman/ 2005/Centre for Health Systems Research & Development, University of the Free State, Bloemfontein, SOUTH AFRICA THE TB PATIENT: QUALITATIVE EVIDENCE OF PERCEIVED FACTORS AFFECTING TREATMENT COMPLIANCE

The purpose of this article is to identify the factors perceived by TB patients as being responsible for noncompliance.

The overall study design is descriptive, but also directed to recommending interventions at policy and practice levels. In the context of the studys aims, the technique of Focus Group Discussion (FGD) was used. Each FGD was conducted with between 7-8 participants at each of the selected nine clinics. People under the age of 16 years of age and patients with treatment for less than 2 months, were excluded because they were perceived to be less experienced in having TB. In total, 85patients participated in the FGDs.

All the questions posed to the participants seemed to be relevant. However, despite the relaxed atmosphere during all the FGDs, the questions related to the side-effects of TB drugs, lack of family support, and the stigma attached to the disease, evoked much stronger reaction from the participants. The existing sociocultural barriers and taboos associated with TB have also been found to be major factors leading to poor completion rates.

The study revealed some important factors encouraging non-compliance. Regarding the attitude of health care providers, expanded communication skills training and optimal patient care, are needed. The existing sociocultural barriers and taboos associated with TB have also been found to be a major factors leading to poor completion rates. Thus, behavior change remains the current viable means of improving treatment compliance and

The research shows that stigma greatly affects the compliance of TB patients. However, the research also suggests that there are a lot of factors that can affect the compliance of patients. It can be the Side-effects of drugs, lack of family support, Patient behavior, health care services factors and a lot more. Thus, the research can be one of the tools to identify factors that can affect the compliance of TB patients in the

The study reveals factors that can affect the compliance of a TB patient. The results can make health care providers understand more what a patient feels thus intervention can be done. It gives us a wider perspective on the patient not just about the disease but on how he/she sees himself/herself having TB. It gives us the chance to intervene not just on the symptom but on the well being of a patient.

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limiting the further spread of TB infection. P. Sukumaran, K.P. Venugopal and Rejoy Simon Manjooran/2002/ Indian Journal of Tuberculosis, Ind. J Tub., 2002,49, 220055 A SOCIAL STUDY OF COMPLIANCE WITH DOTS To analyze social compliance with DOTS, in the field, by studying patients awareness of tuberculosis, its treatment and opinion about the RNTCP strategy of DOTS. The study was conducted in the District TBCentre (DTC), Kottayam, and a medium sized town with hundred percent literacy in Kerala. By random selection, 100 patients registered for DOTS at the DTC were enrolled. Patients with associated medical illnesses were excluded from the study. Awareness about tuberculosis was found to be excellent (91%); 40% were also knowledgeable about its treatment but none knew about DOTS. Marked amelioration of symptoms (27%) was reported after the first month of treatment, going up to 89% by the end of 2nd month; 6% had no benefit while 3% were lost to follow up. Side effects with drugs were reported by 73% (fatigue was the most common complaint) but none was serious enough to interfere with DOTS. At the end of treatment, 91% were satisfied with DOTS, 6% were unhappy and rest had no opinion. Only 29% reported that their acceptance in the family/community had been affected (stigma) due to their diagnosis and treatment for tuberculosis.

country.

The research shows that stigma has only 29% effect on compliance of TB patients. Thus, DOTS is effective not only in curing the disease but it is also effective in terms of the outlook of a patient towards TB. This suggests that the compliance is dependents on how the program is implemented in each country or region.

The research shows that if health care providers will be keen in observing the DOTS, then there will be a great success rate of the program. Awareness and education must be properly observed so that compliance will be achieved.

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