K Alegria-Flores1, B J Weiner2, C A Wiesen3, K L H Lich1, A Van Rie4, J E Paul1, M A Tovar5. 1. Department of Health Policy and Management, University of North Carolina Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina. 2. Department of Global Health, University of Washington, Seattle, Washington. 3. Howard Washington Odum Institute for Research in Social Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. 4. Department of Epidemiology and Social Medicine, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium. 5. Innovación Por la Salud Y Desarrollo, Asociación Benéfica Prisma, Lima, Peru.
Abstract
BACKGROUND: Drug-resistant tuberculosis (DR-TB) treatment is expensive, lengthy, and can cause severe side effects. Patients face socio-economic, psychosocial, and systemic barriers to adherence; poor adherence results in poor treatment outcomes. OBJECTIVE: To estimate the effects of the components of the information-motivation-behavioral skills model on DR-TB treatment adherence. DESIGN: We recruited 326 adults receiving DR-TB treatment and 86 of their health care service providers from 40 health centers in Lima, Peru. The main outcome was adherence (i.e., the proportion of prescribed doses taken by a patient). Exposure measures were adherence information, motivation, and behavioral skills; loss to follow-up during previous TB treatment(s); providers' work engagement; and patient-perceived support from his/her social network. RESULTS: Structural equation modeling revealed that adherence information and motivation had positive effects on adherence, but only if mediated through behavioral skills (β = 0.02, P < 0.01 and β = 0.07, P < 0.001, respectively). Behavioral skills had a direct positive effect on adherence (β = 0.27, P < 0.001). Loss to follow-up during previous treatment had a direct negative effect, providers' work engagement had a direct positive effect, and perceived support had indirect positive effects on adherence. The model's overall R2 was 0.76. CONCLUSION: The components of the information-motivation-behavioral skills model were associated with adherence and could be used to design, monitor, and evaluate interventions targeting adherence to DR-TB treatment.
BACKGROUND:Drug-resistant tuberculosis (DR-TB) treatment is expensive, lengthy, and can cause severe side effects. Patients face socio-economic, psychosocial, and systemic barriers to adherence; poor adherence results in poor treatment outcomes. OBJECTIVE: To estimate the effects of the components of the information-motivation-behavioral skills model on DR-TB treatment adherence. DESIGN: We recruited 326 adults receiving DR-TB treatment and 86 of their health care service providers from 40 health centers in Lima, Peru. The main outcome was adherence (i.e., the proportion of prescribed doses taken by a patient). Exposure measures were adherence information, motivation, and behavioral skills; loss to follow-up during previous TB treatment(s); providers' work engagement; and patient-perceived support from his/her social network. RESULTS: Structural equation modeling revealed that adherence information and motivation had positive effects on adherence, but only if mediated through behavioral skills (β = 0.02, P < 0.01 and β = 0.07, P < 0.001, respectively). Behavioral skills had a direct positive effect on adherence (β = 0.27, P < 0.001). Loss to follow-up during previous treatment had a direct negative effect, providers' work engagement had a direct positive effect, and perceived support had indirect positive effects on adherence. The model's overall R2 was 0.76. CONCLUSION: The components of the information-motivation-behavioral skills model were associated with adherence and could be used to design, monitor, and evaluate interventions targeting adherence to DR-TB treatment.
Authors: Helen R Stagg; Mary Flook; Antal Martinecz; Karina Kielmann; Pia Abel Zur Wiesch; Aaron S Karat; Marc C I Lipman; Derek J Sloan; Elizabeth F Walker; Katherine L Fielding Journal: ERJ Open Res Date: 2020-11-02
Authors: Helen R Stagg; James J Lewis; Xiaoqiu Liu; Shitong Huan; Shiwen Jiang; Daniel P Chin; Katherine L Fielding Journal: Ann Am Thorac Soc Date: 2020-04