The Tuberculosis Behavioral and Social Science Research Forum
Section II. Presentations and Panel Discussions
Psychosocial, Social Structural, and Environmental Determinants
of Tuberculosis Control
Donald E. Morisky, Sc.D., M.S.P.H., Sc.M.
Professor, School of Public Health Department of
Community Health Sciences, University of California, Los Angeles
Day 1, Morning Session
Dr. Morisky presented research results from two randomized studies
of adherence to anti-TB regimens. The first study used cognitive
and behavioral outcome markers, such as knowledge, beliefs, values,
and attitudes, to assess the effectiveness of an educational intervention.
Participants were randomized to one of three intervention groups:
1) educational counseling, 2) incentives/rewards, 3) a combination
of educational counseling and incentives/rewards, or to the control
group. Those who participated in the educational counseling intervention
showed a significantly higher level of medication compliance from
baseline to exit interview. Dr. Morisky identified factors that
may affect drop-out rates, such as ethnic background, gender, unemployment,
homelessness, drug use, HIV status, primary language, and marital
The second study focused on foreign-born adolescentsí adherence
to LTBI treatment. Determinants of these adolescentsí compliance
with and completion of treatment were categorized as individual,
environment, or other.
Individual determinants of compliance included:
- An understanding of the medical regimen;
- Belief in the benefits of treatment;
- Positive attitudes regarding treatment; and
- High levels of self-esteem and self-efficacy.
Environmental determinants of compliance included:
- Family member reinforcement in the home;
- Good patient/provider communication;
- Systematic approaches for patient monitoring, follow-up, and
- Convenience of picking up medication from the clinic; and
- Use of medication containers and cueing behaviors.
Other determinants of completion of care included:
- Regular appointment-keeping behavior;
- High levels of adherence;
- Use of community health workers;
- Reinforcement of positive behaviors by health care staff; and
- Use of peer counselors to clarify health concerns.
During the discussion with Forum participants, Dr. Morisky commented
further on communication about non-adherence between patients and
providers. Patients are often afraid of talking about non-adherence,
and social desirability pressures further influence communication
between patients and providers. To address this issue, families
should be encouraged to provide positive reinforcement for patients
who are adherent to their treatment regimens.
here for slideset of presentation
Released October 2008
Centers for Disease Control and Prevention
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
Division of Tuberculosis Elimination - http://www.cdc.gov/tb
Please send comments/suggestions/requests
CDC/Division of Tuberculosis Elimination
Communications, Education, and Behavioral Studies Branch
1600 Clifton Rd., NE - Mailstop E-10, Atlanta, GA 30333