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U.S. Department of Health and Human Services

  
Education Materials > Publications > Improving Patients Adherence to TB Treatment > Predicting Patient Adherence

Improving Patient Adherence to Tuberculosis Treatment (1994)

Predicting Patient Adherence

Always be aware that any patient can be nonadherent. Although many health care providers believe that they can predict whether a particular patient will take medication as prescribed, research data indicate that providers on the average are correct only about 50% of the time (5,13).

Know the patient's history. Once you know more about your patient, you can predict adherence more accurately. One of the strongest predictors is a patient's history of adherence. Try to determine whether the patient has had difficulty maintaining adherence with TB medications or with other regimens. Although poor adherence is not a personality trait, a history of adherence problems, particularly with TB medications, will help you anticipate a problem.

Ask the patient. Sometimes a patient may have strong reasons for not wanting to take medications. Ask your patient about his or her knowledge and beliefs concerning the causes and treatment of TB. Asking about your patient's beliefs is an important way of identifying signals for nonadherence.

A CDC study concluded that there are many reasons why a person might not want to take TB medications. For example,

  • Immigrants and refugees may fear that having TB disease or infection will make them subject to legal action, such as deportation, so they may give the appearance of being adherent by picking up refills (although they may not take the medicines).
  • Many foreign-born persons have histories of BCG inoculation and believe that they cannot develop TB.
  • Persons vulnerable to TB may have other life demands that are of higher priority to them than preventing or curing TB.
  • Many people think of public health as part of the "system" that they have come to mistrust; some may believe that public health interventions will actually cause disease or attempt to hurt a group of people because of their race.
  • Some patients who use alcohol or drugs fear the side effects that may result from their taking TB medications while taking other substances.
  • Having TB carries a stigma for many people and may lead to shame, fear of social rejection, or fear of the loss of a job.
  • Attending a treatment center for TB may mean taking time off work or other essential competing activities.
  • Many patients are afraid that TB drugs will cause dangerous side effects and lead to illness or costly medical interventions.
  • Some groups may not believe that health care providers can correctly diagnose or treat TB and that the drugs prescribed are ineffective or inappropriate for members of their racial or national group.
  • Many groups have strong cultural beliefs about health and treatment for disease that may compete with the prescribed regimen for TB.

Clearly, people may have reasons, which are logical to them, for not taking medications. Identify these reasons and provide health education (see Assessing Patients' Perceptions about TB).

Ask patients their concerns about TB. Patients who believe that their disease or infection is a serious problem are more likely to take TB medications. Ask patients which close friends or family members are concerned about their health and will help them remember to take medications. In general, it seems that adherent patients are those who believe that they have the support of family members and of the doctor or other providers. Find out if your patients understand what you have told them about TB; ask them to explain it in their own words. Adherent patients tend to understand the causes of TB and its treatment.

Look for early warning signs. It is important for you to monitor for adherence early during treatment in order to anticipate future problems. It is probably correct to say that "adherence predicts adherence," so the patient's own behavior may be the strongest cue to what the patient will do in the future. However, patients with active disease who are initially adherent will begin to feel well after a few weeks of treatment and may then forget their medication or believe that it is no longer needed. Therefore, even patients who have followed the regimen early in treatment should be monitored and given assistance to ensure continuing adherence after symptoms have been relieved.

Avoid reliance on demographic information. Keep in mind that demographic factors (such as age, sex, race, ethnicity, occupation, income, and education) are inconsistent or unreliable predictors of adherence with TB medications. The real predictors of nonadherence may be poor access to health information or services.

 


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

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