Methodology: A qualitative methodological approach was used in this study, as it allows for an in-depth investigation and understanding of health-seeking behavior in MDR-TB patients. In particular, the health belief model is an ideal theoretical framework for this study, as it provides a broad basis for investigating the health-seeking behavior of MDR-TB patients.
Chapter Two
Drug-Resistance and Tuberculosis
Lui, Shilkret, and Finelli (1998) found that a significant proportion of physicians did not initially treat their TB patients according to the recommendations of the Centers for Disease Control (CDC) and the American Thoracic Society (ATS), and suggested that physicians should be better informed about the level of drug resistance in the community they serve to ensure that patients adhere to appropriate initial treatment. Since the global resurgence of tuberculosis and associated widespread drug resistance in the 1990s, DOT has now become the World Health Organization's (WHO) primary strategy for effective tuberculosis control, ensuring treatment success and to prevent the development of acquired drug resistance (Yew, 1999).
The Dynamics of Non-adherence in Tuberculosis Control
The nature of the study was to re-evaluate the role of time in understanding compliance behaviour. Other factors that may influence healthcare workers' social distance from patients are the nature of the disease itself as well as its transmission.
Patients Decision-Making Capacity
He argues that the greatest danger of the power of detention is that it will be seen as the answer to failing disease control programs, and should therefore be considered a last resort. It is interesting to note that, despite comments like this, biomedicine has not yet managed to 'control' tuberculosis, but those working at the other end of the spectrum have been committed to doing so.
Tuberculosis 'Control'
The study of explanatory models focuses on the patient's explanations of the etiology, symptoms, severity, social meaning and treatment of the disease. She discovered that the explanatory models of the migrant farm workers in her research have similarities with the medical model of tuberculosis.
Understanding Health Behaviour: Models of Illness and Health
Douglas Reid and Christensen (1988) argue that the theory of reasoned action (TRA) addresses some of the shortcomings of the HBM. According to Manicas and Secord (1982), qualitative research is based on an "open systems" assumption, where the observational contexts (and the observer) are part of the study itself.
The Study Site
The Health Belief Model, in particular, serves as an ideal theoretical framework for this study as it provides a broad canvas for exploring the health-seeking behavior of MOR-TB patients. The HBM was consequently used in the context of this study to facilitate a culture-centred qualitative investigation into the health-seeking behavior of MOR-TB patients, with minimal theory-driven assumptions. The heuristic value of the Health Belief Model, for the purpose of this study, lies in the ideal balance it provides between theory-driven and data-driven research.
Participants
Data Collection
A semi-structured 90-minute focus group schedule was designed to address the study objectives (see Appendix 2). The focus group discussions were audio-recorded and conducted in Zulu, taking into account the ethnicity of the subjects. The researcher made a detailed summary of each of these discussions, to complement the verbatim transcripts of the focus group discussions.
Ethical Considerations
However, the approach of developing a code based on previous research places the researcher approximately in the middle of the continuum. Most patients described their experience with healthcare treatment as discouraging. Most male participants argued that they were not sufficiently informed about their health status during inpatient treatment and believed that they had a right to access.
Poor Professional-Patient Communication
Also of concern with regard to communication between professionals and patients was the apparent lack of adequate explanation by healthcare professionals about patients' responses to tuberculosis treatment. One female participant reported that healthcare professionals mismanaged her treatment because she experienced side effects from the treatment that were not adequately managed. In this regard, most participants agreed that they received an inconsistent level of care from healthcare professionals upon admission.
Attitudes Towards TBIMDR-TB and Treatment Regimens
Most of the male participants reported that their lifestyle habits (smoking, alcohol abuse and poor eating habits) may have made them vulnerable to MDR-TB or in some cases even worsened their health status. One participant (male) reported that MDR-TB is curable and attributed “ukungaziphathi kahle wethu” (patients not being treated) as a primary reason for relapse of the disease. Another participant referred to MDR-TB as 'AIDS number two', reflecting his belief in the incurability of the disease.
Psychological Stress Related to TB/MDR-TB
Some patients complained of being prematurely discharged from the hospital despite the lack of sputum conversion, which allegedly led to a relapse of the TB disease and a return to the hospital. These patients have the potential to spread the disease as a primary form of infection to unsuspecting family and community members. Furthermore, it is not possible to monitor whether such patients take preventive measures to ensure that they do not spread the disease.
Perception of AdherencelNon-adherence in the Development of MDR-TB
One male participant reported that he felt that the healthcare professional blamed him for poor treatment management, when in fact he was unaware of the duration of the treatment protocol. This again emphasizes the need for a counseling program to ensure a shared understanding of the entire treatment protocol between patients and healthcare professionals. One male participant reported that he believed health workers failed to diagnose MDR-TB early and instead treated him for tuberculosis, causing the disease to intensify.
Patients Understanding and Perceptions of MDR·TB and TB
The majority of male and female participants reported that when they first started receiving treatment for TB, they were unaware of the possibility of developing MDR-TB. In contrast, most female participants attributed the persistence of TB symptoms, after completion of TB treatment, to the possibility of the disease becoming more complicated, rather than the possibility of contracting MDR-TB. However, one female participant reported that she understands MDR-TB as a disease in which people never fully recover or return to their previous level of physical functioning.
Alternative Sources of Diagnosis and Treatment Sought
Two participants reported that they felt internal symptoms of illness before seeking medical help. In this case, community members may interpret the symptoms of MDR-TB as part of the HIV/AIDS syndrome. Some patients also reported that when they visit their family, they feel affected by having limited contact with them due to the fear of passing the disease on to them.
Social and Financial Consequences of MDR-TB
The Health Belief Model, in particular, provides a broad canvas for exploring the health-seeking behavior of MDR-TB patients. The majority of male participants considered the differences between TB and MDR-TB to be related to the differences in the treatment of the two conditions. One participant referred to MDR -TB as 'AIDS number two', reflecting his belief in the incurability of the disease.
Health Motivation
Thus, their perception of the benefits of their current course of action was negative due to the lack of rapid improvement in their symptomatology. Within such a context, health-seeking behavior will be determined almost exclusively by the severity of the disease. The latter was related to the approval of decisions (such as hospitalization) by the head of the household.
Perceived Barriers
An interesting finding regarding patients' confidence in their ability to successfully perform health-benefiting actions was the reception they received from health professionals upon admission. Most of the male participants reported 'ukuzenyeza' (low self-esteem), which negatively affected their ability to make appropriate decisions about their health care after becoming ill. This was exacerbated by a lack of mutual respect, fear of victimisation, bullying and a lack of communication between healthcare professionals and patients.
Chapter Six
Conclusion and Recommendations
Conclusions
In terms of personnel needs, it is clearly important to provide continuous programs of continuing education and psycho-social support in order to systematically influence the orientation and approach of health care personnel and to root a person at the center and not a central disease. institutional culture. The findings of this study would ideally be complemented by ethnographic insights into health care professionals' perceptions of their health care behavior. Future and more focused research on this issue is required, including health care personnel and traditional healers as part of the study population.
Limitations of the Study
For example, based on the findings of this study, patients described conflicting perceptions of the DOT strategy. This insight into the health-seeking behavior of MDR-TB patients came about through my idiosyncratic interpretation of the emerging data. The influence of program acceptability on public health policy effectiveness: an examination of directly observed therapy for tuberculosis.
Operational Definitions
Focus Group Schedule
I collect data to understand your perspectives and behavior regarding multidrug-resistant tuberculosis and your experience with the treatment you have received. I don't need your name and what you have to say remains anonymous. Information from the group discussions will be used for research purposes and will help improve the future treatment of MDR-TB patients.
Focus Group Transcripts
Another participant said that he was initially told that he had TB and was subsequently put on treatment. One participant said that he had delayed injections, but his sputum did not change to negative. Another participant also claimed that he was not affected by the diagnosis of MDR-TB.
Ethical Clearance Letters
I am a Masters student in Clinical Psychology at the Department of Psychology at the University of Durban-Westville (UDW) and, as part of my course requirements, would like to conduct a tuberculosis study at King George V Hospital. Please find attached a copy of my research protocol, the ethical approval from the UDW Ethics Committee and a letter from my supervisor indicating his support for my research. The study has received ethical approval from the University of Durban-Westville Ethics Committee and we trust that you will see fit to allow this student to conduct his research in your hospital.
KING GEORGE V HOSP
RESEARCH ADMINISTRATION
MR. SVALJEE
DEPT. OF CLINICAL PSYCHOLOGY Dear Sir/Madam
ETHICAL CLEARANCE: NUMBER 991138
