Adherence to DOTS Therapy and its Impact on Quality of Life

 

Anjali Kumari¹, Raman Kalia², Ravita Verma³

¹Tutor, Saraswati Nursing Institute, Dhainpura, Roop Nagar.

²Principal, Saraswati Nursing Institute, Dhainpura, Roop Nagar.

³Professor, Saraswati Nursing Institute, Dhainpura, Roop Nagar.

 

ABSTRACT:

A descriptive study “to assess the adherence to DOTS therapy and its impact on quality of life among clients registered at selected DOTS centers of Punjab”. The objectives of the study were to assess the adherence to DOTS therapy among patients who were registered at selected DOTS centers in Punjab, to identify the problems related to adherence among the patients, to assess the impact of DOTS therapy on the quality of life of patients registered at selected DOTS centers of Punjab, to assess the association between adherence to DOTS treatment and socio-demographic variables. A quantitative research approach was designed, and 100 subjects were selected through convenient sampling. The results of the study showed that the majority of the subjects (56%) were non-adhered, while 44% adhered to DOTS treatment. The results revealed that the majority of the subjects 74(74%), felt the unpleasant effects of medication, and 97(97%) felt weird on medication. While 83(83%) subjects felt negative feelings such as blue mood, despair, anxiety, and depression, the majority of the subjects 83(83%) were not satisfied with their health status. Findings revealed that the most affected domain of quality of life was the environment domain (21.41±2.68), physical domain (19.36±3.21), and psychological domain (16.31±1.87). Whereas the social domain is 7.60±1.66 lowest. The study emphasized the need to strengthen adherence to DOTS therapy among the subjects and then reduce the impact of tuberculosis on quality of life.

 

 

INTRODUCTION:

Tuberculosis remains a major public health problem worldwide and the leading cause of morbidity and mortality.¹ Despite advances in diagnosis and therapy, nearly 10 million TB cases were reported worldwide in 2017, and an estimated 1.6 million deaths were reported in 2015. TB has an impact on health-related quality of life.²

 

Tuberculosis is a bacterial infection transmitted by inhaling tiny droplets from an infected person when they cough or sneeze. It primarily affects the lungs but can affect any part of the body, including the abdomen, glands, bones, and nervous system.³ TB is caused by a type of bacteria called Mycobacterium tuberculosis. It is transmitted when a person with active TB disease coughs or sneezes and another person inhales the expelled droplets of TB bacteria.⁴

 

DOTS stands for Directly Observed Treatment Short Course. It is a strategy to reduce tuberculosis cases. In DOTS centres, nurses are responsible for ensuring that patients take their medication. It is divided into two parts, including first-line drugs and second-line drugs.  DOTS involves treatment with a four-drug regimen. These were isoniazid, rifampicin, pyrazinamide, and ethambutol for 6–9 months.⁵

QOL is defined as a person's perception of their physical and mental health. It encompasses the broad areas of physical, psychological, economic, spiritual, and social well-being. ⁶ According to the WHO, health is a state of complete physical, mental, and social well-being and not just the absence of disease or infirmity. The importance of patient-perceived health status and the recognition gained or increased in disease management and outcomes. One of the results of the study showed that people with chronic health problems rate mental and social health scores almost as highly as physical scores. QOL has become a recognized outcome measure in clinical research, and advances have been made in assessing the impact of many diseases on QOL.⁷

 

Despite recent advances through international initiatives, TB still poses a serious public health threat in many underdeveloped countries. It is difficult for tuberculosis patients to adhere to a long-term treatment plan^{. 8} Removing specific barriers to patient adherence as well as promoting facilitators are necessary to improve patient outcomes. The majority of TB patients are curable with today's anti-TB drugs. However, the medication must be taken exactly as directed to be successful.

 

PROBLEM STATEMENT:

A Descriptive Study to Assess the Adherence to Therapy and Its Impact on Quality of Life Among Clients Registered at Selected DOTS Centers of Punjab (2021- 2023).

 

OBJECTIVES:

1.     To assess the adherence to DOTS therapy among patients who were registered at selected DOTS centers in Punjab.

2.     To identify the Problems related to adherence among the patients.

3.     To assess the impact of DOTS therapy on the quality of life of patients registered at selected DOTS centers in the Punjab

4.     To assess the association between adherence to DOTS treatment and socio-demographic variables.

 

METHODOLOGY:

Research Approach: Quantitative Research Approach.

Research Design: Descriptive research design.

The setting of the study:

The present study was conducted in three DOTS centers Civil Hospital Kurali, Civil Hospital Morinda, and Civil Hospital Kharar in Punjab.

 

Sample size:

A subset of the population comprises those selected to participate in the study.

In this study, the sample consists of 100 tuberculosis patients who fulfilled the inclusion criteria, were included.

 

Sampling Technique:

Convenience Sampling technique was used for the present study.

 

Sampling Criteria:

Inclusion Criteria:

1.   The patients suffering from Tuberculosis who were reporting in selected DOTS centers in Punjab.

2.   Those who were registered and receiving DOTS therapy.

3.   Those patients who were available at the time of data collection.

 

Exclusion Criteria:

The patients who were not willing to participate in the study.

 

Description of Tools: - In this study, the investigator used the following tools;

·       Socio-demographic data.

·       Standardized DAI (Drug Attitude Inventory) rating scale.

·       Standardized MARS (Medication Adherence Rating Scale).

·       Checklist to identify the problems related to adherence to DOTS therapy.

·       WHO Quality of life.

 

Data collection procedure:

The investigator obtained the permission from Senior Medical Officer of Civil Hospital Kurali, Civil Hospital Kharar and Civil Hospital Morinda to conduct the final study. The data was collected during end of January and February 2023. The convenient sampling technique was used to select subjects. The investigator explained the purpose of study to the subjects suffering from tuberculosis and assured about confidentiality of the data. The informed consent was taken from the subjects prior to the data collection. The sum of patients who were registered in DOTS centers refused to participate in the study due to lack of time and not willing to participate in the study. The investigator assesses the adherence to therapy and its impact on quality of life among clients registered at selected DOTS therapy and it took almost one hour for each subject to fulfil the tool. The data was collected from 100 patients, who fulfilled the inclusion criteria. All subjects cooperated well with the investigator during the data collection.

 

Plan for data Analysis

It is the orderly linking and combination of research data. Data was scheduled to be analysed by IBM statistics SPSS 20 ‘’ based on the objectives of the study’’. The data collected by the investigator was transfer to a master sheet organized for each part of the tool. The data were analysed using descriptive statistics and inferential statistics i.e., calculation of frequency and percentage. Presentation of the data in the appearance of tables and bar charts.

 

RESULTS:

Table -1 Frequency and percentage distribution of subjects regarding adherence to DOTS therapy as per Drug Attitude Inventory Scale.

(N=100)

Score	Adherence category	Frequency/ percentage	Mean	Standard deviation
Positive score	Adherent	44 (44%)	6.31	5.897
Negative score	Nonadherent	56 (56%)	-7.07	3.850

Table no.1 depicts that more than half of the subjects, i.e., 56 (56%), were non-adherent to DOTS therapy, whereas 44 (44%) subjects were adherent to DOTS therapy as per the drug attitude inventory scale. Thus, the findings, revealed that still more recommendations or efforts were required to improve adherence to DOTS therapy, as, despite these efforts, almost half of the patients did not adhere.

 

Intervention: Each subject was explained with the help of a pamphlet by the investigator related to the importance of adherence to DOTS therapy and its impact on quality of life.

 

 

 

Table 2: Frequency and Percentage distribution of adherent and non-adherent subjects according to socio-demographic variables N=100

Sr No.	Demographic variable	Adherent (N=44)		Non-adherent (N=56)		Total
		Frequency	Percentage	Frequency	Percentage
1.	Age in years 20-40 41-60 61-70 Above 70	34 08 01 01	77.28% 18.18% 02.27% 02.27%	33 15 06 02	58.92% 26.78% 10.71% 03.59%	67 (67%) 23(23%) 07(07%) 03(03%)
2.	Gender Female Male	26 18	59.09% 40.91%	25 31	44.64% 55.36%	51(51%) 49(49%)
3.	Education No-formal education Primary education Secondary education High school education Graduation Post-graduation	02 08 06 15 08 05	04.54% 18.18% 13.64% 34.09% 18.18% 11.37%	06 08 18 14 09 01	10.71% 14.28% 32.15% 25.01% 16.07% 01.78%	08(08%) 16(16%) 24(24%) 29(29%) 17(17%) 06(06%)
4.	Occupation Employed Unemployed Private job Government job	10 20 12 02	22.72% 45.47% 27.27% 04.54%	14 32 08 02	25.00% 57.14% 14.28% 03.58%	24(24%) 52(52%) 20(20%) 04(04%)
5.	Marital status Married Unmarried Single Widow or widower	28 14 02 00	63.64% 31.82% 04.54% 00.0%	35 15 00 06	62.5% 26.8% 00.0% 10.7%	63(63%) 29(29%) 02(02%) 06(06%)
6.	Family income Below 5000/- 5001-10,000/- 10,001-20,000/- Above 20,000/-	01 12 25 06	02.27% 27.27% 56.81% 13.65%	02 20 26 08	03.57% 35.72% 46.42% 14.29%	03(03%) 32(32%) 51(51%) 14(14%)
7.	Type of family Joint family Nuclear family	19 25	43.18% 56.82%	18 38	32.14% 67.86%	37(37%) 63(63%)
8.	Area of residence Rural Urban	13 31	29.54% 70.46%	11 45	19.64% 80.36%	24(24%) 76(76%)
9.	Religion Hindu Sikh Muslim Christian	29 15 00 01	65.00% 33.00% 00.00% 02.00%	37 17 01 00	67.00% 31.03% 01.07% 00.00%	66(66%) 32(32%) 01(01%) 01(01%)
10 (a)	Lifestyle factor smoking Yes No	04 40	09.09% 90.91%	01 55	01.78% 98.22%	05(05%) 95(95%)
(b)	Lifestyle factor alcohol Yes No	06 38	13.63% 86.37%	04 52	07.14% 92.86%	10(10%) 90(90%)
11.	Source of information regarding the DOTS treatment ASHA worker Television/radio Newspaper Health professional	01 00 00 43	02.27% 00.00% 00.00% 97.73%	12 01 03 40	21.43% 01.78% 05.36% 71.43%	13(13%) 01(01%) 03(03%) 83(83%)
12.	Satisfaction with information received from healthcare providers regarding the importance of DOTS therapy Excellent Unsatisfactory Good	01 00 43	02.27% 00.0% 97.73%	04 15 37	07.14% 26.78% 66.08%	05(05%) 15(15%) 80(80%)
13.	Type of cases New sputum-positive case Treatment after default Relapse	44 00 00	100.0% 000.0% 000.0%	43 06 07	76.78% 10.72% 12.05%	87(87%) 06(06%) 07(07%)
14.	History of associated disease Hypertension Diabetes mellitus Any, other specify None	01 00 00 43	02.27% 00.00% 00.00% 97.73%	02 08 05 41	03.57% 14.28% 08.92% 73.23%	03 (03%) 08(08%) 05(05%) 84(84%)
15.	Duration of the treatment 1 month 2-3 month 3-5 month 6-8 month	01 43 00 00	02.27% 97.73% 00.00% 00.00%	15 21 12 08	26.78% 37.05% 21.42% 14.30%	16(16%) 64(64%) 12(12%) 08(08%)
16.	The phase of DOTS treatment Intensive phase Continuation phase	44 00	100.0% 000.0%	42 14	75.00% 25.00%	86(86%) 14(14%)

 

Table 2: More than half of the subjects, i.e., 67 (67%), were in the age group of 20–40 years. Out of these, 34 (77.28%) subjects adhered, while 33 (58.92%) subjects did not adhere to DOTS therapy.

 

Most of the subjects, i.e., 51 (51%), were female. Out of these, 26 (59.09%) females belonged to the adherent group, while 25 (44.64%) females belonged to the non-adherent group.

 

Education status shows that 29 (29%) of subjects were in high school education. Out of these, 15 (34.09%) subjects adhered and 14 (25.01%) subjects did not adhere to DOTS therapy.

 

As per the occupation of the subjects, 52 (52%) were unemployed. Out of these, 20 (45.45%) subjects belonged to the adherent group, and 32 (57.14%) subjects belonged to the non-adherent group.

 

The majority of the subjects, i.e., 63 (63%), were married. Out of these, 28 (63.64%) subjects adhered, while 35 (62.50%) subjects did not adhere to DOTS therapy.

 

Half of the subjects, i.e., 51 (51%), had incomes of 10,001–20,000 rupees per month (in rupees). Out of these, 25 (56.81%) subjects belonged to the adherent group, and 26 (46.42%) subjects belonged to the non-adherent group.

 

The majority of the subjects, i.e., 63 (63%), had nuclear families. Out of these, 25 (56.82%) subjects adhered, while 38 (67.86%) subjects did not adhere to DOTS therapy.

 

The majority of the subjects (76%) resided in urban areas. Out of these, 31 (70.46%) subjects adhered and 45 (80.36%) did not adhere to DOTS therapy.

 

Most of the subjects, i.e., 66 (66%), belonged to the Hindu religion. Out of these, 29 (65.0%) subjects adhered, while 37 (67.0%) subjects did not.

 

Most of the subjects, i.e., 95 percent, had not smoked. Out of these, 40 (90.90%) subjects adhered and 55 (98.22%) did not adhere to DOTS therapy. 90% of the subjects were non-alcoholics. Out of these, 38 (86.37%) subjects adhered, while 52 (92.86%) did not adhere to DOTS therapy.

 

The majority of the subjects (83%) got information regarding DOTS therapy through a health professional. Out of these, 43 (97.73%) subjects adhered and 40 (71.43%) did not adhere to DOTS therapy.

 

Most of the subjects (80%) had good satisfaction regarding information received from health care personnel about the importance of DOTS therapy. Out of these, 43 (97.73%) subjects adhered and 40 (71.43%) did not adhere to DOTS therapy.

 

The majority of the subjects, i.e., 87 (87%), were new sputum-positive cases. Out of these, 44 (100%) subjects belonged to the adherent group, and 42 (75.0%) subjects belonged to the non-adherent group.

 

The majority of the subjects (84%) were not suffering from any other disease condition. Out of these, 43 (97.73%) subjects adhered and 41 (73.23%) did not adhere to DOTS therapy.

Most of the subjects (64%) had a duration of treatment for tuberculosis between 2 and 3 months. Out of these, 43 (97.73%) subjects belonged to adherents, and 21 (37.5%) subjects belonged to non-adherents.

 

The maximum number of subjects (86%) were in the intensive phase. Out of these, all 44 (100%) subjects belonged to the adherent group, and 42 (75.0%) subjects belonged to the non-adherent group to DOTS therapy.

 

Table 3: Item analysis of Drug Attitude Inventory Scale to measure adherence to DOTS therapy. (N=100)

Sr. No.	Questions	True	False
1.	I don’t need to take medication once I feel better	53%	47%
2.	For me, the good things about medication outweigh the bad	45%	55%
3.	I feel strange ‘’dopped up’’ on medication	82%	18%
4.	Even when I am not in hospital, I need medication regularly	35%	65%
5.	If I take medication, it’s only because of pressure from other people	36%	64%
6.	I am more aware of what I am doing of what is going on around me when I am on medication	44%	56%
7.	Taking medications will do me no harm	59%	41%
8.	I take medications of my own free choice	61%	39%
9.	Medications make me feel more relaxed	65%	35%
10.	I am no different on or off medication	72%	28%
11.	The unpleasant effects of medication are always present	74%	26%
12.	Medications make me feel tired and sluggish	80%	20%
13.	I take medication only when I feel ill	83%	17%
14.	Medications are slow-acting poisons	73%	27%
15.	I get along better with people when I am on medication	68%	32%
16.	I can’t concentrate on anything when I am taking medications	60%	40%
17.	I know better than the doctors when to stop taking medications	67%	33%
18.	I feel more normal on medication	73%	27%
19.	I would rather be ill than taking medication	65%	35%
20.	It is unnatural for my mind and body to be controlled by medications	69%	31%
21.	My thoughts are clearer on medication	76%	24%
22.	I should keep taking medication even if I feel well	67%	33%
23.	Taking medication will prevent me from having a breakdown	49%	51%
24.	It is up to the doctor to decide when I should stop taking medication	40%	60%
25.	Things that I could do easily are much more difficult when I am on medication	54%	46%
26.	I am happier and feel better when I am taking medications	60%	40%
27.	I am given medication to control behavior that other people (not myself) don’t like	70%	30%
28.	I can’t relax on medication	60%	40%
29.	I am in better control of myself when taking medication	84%	16%
30.	By staying on medications, I can prevent myself from getting sick	86%	14%

 

TABLE 3: More than half of the subjects, i.e., 53 (53%), felt that they didn’t need to take medication once they felt better, but 47% of the of the subjects disagreed with the same.

 

Less than half, i.e., 45 (45%) subjects, felt that the good things about medication outweighed the bad for them, while 55 (55%) subjects did not.

 

The majority of the subjects, 82 (82%), felt strangely ‘’ dopped up’’ on medication, and only 18 (18%) subjects felt strangely dopped up on medication.

More than half of the subjects (35%) agreed that they needed medications regularly even when they were not in the hospital, whereas 65 (65%) subjects did not agree on the same.

 

Less than half of the subjects, i.e., 36 (36%), believed that they took medication due to pressure from other people, but the majority of subjects, 64 (64%), believed that they took medication for themselves.

 

Less than half (44%) were aware of what they were doing and what was going on around them while on medication, whereas 56 (56%) were not aware of what they were doing or what was going on around them while on medication.

 

More than half of the subjects, 59 (59%), believed that medications would not do any harm to them, while 41 (41%) believed that medication could harm them.

The majority of the subjects, 61 (61%), took medications of their own free choice, while 39 (39%) were not taking medications of their own free choice.

 

More than half of the subjects, 65 (65%), felt that medications made them more relaxed, while 35 (35%) did not feel so.

 

 

The majority of the subjects (72%) were not different while on or off medication, whereas 28 subjects (28%) were different while on or off medication.

 

The majority of the subjects, 74 (74%), felt that unpleasant effects of medication were always present, but 26 (26%) did not feel so.

 

The majority of the subjects, i.e., 80 (80%), felt that medication makes them tired and sluggish, while 20 (20%) respondents did not feel so.

 

The majority of the subjects (83%) took medication only when they felt ill, while 17 (17%) did not take medication only when they felt ill.

 

The maximum number of subjects, i.e., 73 (73%) believed that medications were slow-acting poisons, while 27 (27%) did not believe so.

 

The maximum number of subjects, 68 (68%), got along better with people while on medication, whereas 32 (32%) subjects were not able to do so.

 

Nearly half of the subjects (60%) were not able to concentrate on anything while taking medication, whereas 40% of the subjects were able to concentrate while on medication.

 

More than half of the subjects, i.e., 67 (67%), believed that they knew better than the doctor when to stop taking medication, while 33 (33%) subjects did not agree with this.

 

The majority of the subjects (73%) felt more normal while on medication, but 27 subjects did not feel so.The 65 (65%) subjects believed that they would rather be ill than take medication, whereas the 35 (35%) subjects did not believe so.

 

More than half of the subjects, i.e., 69 (69%), agreed that it was unnatural for their mind and body to be controlled by medications, but 31 (31%) subjects did not agree with this.

 

The majority of the subjects, 76 (76%), had clearer thoughts about medication, whereas 24 (24%) did not.

The 67 (67%) subjects agreed that they should keep taking medication even if they feel well, but 33 (33%) subjects did not agree on the same.

 

Nearly half of the subjects, i.e., 49 (49%), believed that taking medication would prevent them from having a breakdown, while 51 (51%) did not believe so.

 

Less than half of the subjects (40%) agreed that it was up to the doctor to decide when they should stop taking medication, whereas 60% of the subjects did not agree on the same.

More than half of the subjects, i.e., 54 (54%), felt that things they could do easily were much more difficult when they took medication, while 46 (46%) subjects did not feel so.

 

More than half of the subjects, i.e., 60 (60%), were happier and felt better when taking medication, whereas 40 (40%) patients did not feel so.

 

The majority of the subjects (70%) do not need to take medication to control behaviours that other people don’t like, whereas 30 percent of the subjects need medication to control behaviours that other people don’t like.

More than half of the subjects, i.e., 60 (60%), felt relaxed while on medication, whereas 40 (40%) subjects did not feel so.

 

The majority of the subjects, i.e., 84 (84%), felt that they controlled themselves better when taking medication, while 16 (16%) subjects were not able to control themselves while on medication.

 

The majority of the subjects, i.e., 86 (86%), felt that by staying on medications, they could prevent themselves from getting sick, while one-third of the subjects, i.e., 14 (14%), did not feel so.

 

Table 4: Item analysis of MARS (Medication Adherence Rating Scale)  (N=100)

Sr No.	Questions	Yes (1) f (%)	No (0) f (%)
1.	Do you ever forget to take your medication?	15 (15.0%)	85(85.0%)
2.	Are you careless at times about taking your medication?	15 (15.0%)	85(85.0%)
3.	When you feel better, do you sometimes stop taking your medication?	18(18.0%)	82(82.0%)
4.	Sometimes if you feel worse when you take the medication, do you stop taking it?	30(30.0%)	70(70.0%)
5.	I take my medication only when I am sick	27(27.0%)	73(73.0%)
6.	It is unnatural for my mind and body to be controlled by medication	34(34.0%)	66(66.0%)
7.	My thoughts are clearer on medication	42(42.0%)	58(58.0%)
8.	By staying on medication, I can prevent getting sick	55(55.0%)	45(45.0%)
9.	I feel weird, like a ‘zombie’ on medication	97(97.0%)	03(03.0%)
10.	Medication makes me feel tired and sluggish	71(71.0%)	29(29.0%)

 

Table-4 Majority of the subjects 85(85%) were not forget to take their medication and were not careless of time but 15(15%) subjects were forgetting to take their medication and similarly careless of time about taking medication.

Most of the subjects 82(82%) does not stop taking medication when they felt better but 18(18%) subjects stop taking medication once they feel better.

 

Majority of subjects 70(70%) do not stop taking the medication when they feel worse. More than half of the subjects 73(73%) took medication only when they feel sick while 27(27%) subjects do not take medication only when they feel sick.

 

Less than half of the subjects i.e,34(34%) were agreed that it was unnatural for their mind and body to be controlled by medications but 66(66%) subjects were not agreed to this.

 

Less than half of the subjects 42(42%) had clearer thoughts about medication whereas 58(58%) subjects had not.

 

Majority of the subjects 55(55%) felt that by staying on medications can prevent themselves from getting sick while on third of the subjects i.e, 45(45%) were not felt so.

 

Most of the subjects 97(97%) do not feel weird like a ‘zombie’ on medication. Less than half of the subjects i.e, 71(71%) felt that medication makes them tired and sluggish while 29(29%) respondents were not felt so.

 

Table 5: Checklist to identify the problems related to adherence to DOTS therapy among the patients visiting at DOTS Centers of Punjab

(N=100)

Sr. No.	Questions	Yes (1) f (%)	No (0) f (%)
1.	Unpleasant effects of medication	74%	26%
2.	Feeling tired and sluggish	80%	20%
3.	Inability to concentrate on anything	60%	40%
4.	Not feeling relaxed on medication	60%	40%
5.	Easy to do things without medication	54%	46%
6.	Feeling weird on medication	97%	03%
7.	Physical pain prevents from doing daily activities	85%	15%
8.	Negative feelings such as blue mood, despair, anxiety, depression	83%	17%
9.	Lack of support from family and friends	55%	45%
10.	Unsatisfied with conditions of living place	61%	39%
11.	Unhealthy physical environment	63%	37%
12.	No satisfaction with health	83%	17%
13.	Availability of information needed in day-to-day life	53%	47%

Table 5: Majority of the subjects 74(74%) felt unpleasant effects of medication but 20(20%) subjects were not experienced so and also Majority of the subjects 80(80%) felt medication makes them tired and sluggish while 20(20%) respondents were not felt so. 60(60%) subjects were not able to concentrate on anything when taking medication whereas 40(40%) subjects were able to concentrate while on medication. More than half of subjects i.e, 60(60%) felt relaxed while on medication whereas 40(40%) subjects were not felt so. More than half of the subjects i.e, 54(54%) felt that without medication easy to do things whereas 46(46%) subjects were not felt so.

 

Most of the subjects 97(97%) do not feel weird medication and Majority of the subjects 85(85%) experienced physical pain that prevents them from doing daily activities. Majority of the subjects 83(83%) felt negative feeling such as blue mood, despair, anxiety, depression and more than half of the subjects 55(55%) were unsatisfied with the support received from their family and friends. While 61(61%) subjects were dissatisfied of conditions of living place. 63(63%) of the subjects had unhealthy physical environment. While majority of the subjects 83(83%) were not satisfied with their health. 53(53%) of the subjects had a lack availability information of needed in day-to-day life.

 

Table 6: Mean and Standard Deviation of domains as per WHO-QOL scale to assess QOL of subjects

The raw score of mean and standard deviation

 

According to the findings, the most affected domain of quality of life was environment domain 21.41±2.68. Secondly physical domain of the respondents with mean score 19.36± 3.21. Followed by the psychological domain 16.31±1.87. Whereas, the mean of social domain of the Quality of Life was 7.60±1.66 lowest.

 

 

Table 7: Association between socio-demographic variables and adherence to DOTS therapy among patients suffering from tuberculosis.

Socio-demographic variable	Adherent	Non-adherent	Total	SIGNIFICANCE
	f (%)	f (%)	f (%)	Chi-square	P value	df	Level of significance
Age in years 20-40 41-60 61-70 Above 70	34(77.28%) 08(18.18%) 01(02.27%) 01(02.27%)	33(58.92%) 15(26.78%) 06(10.71%) 02(05.59%)	67(67%) 23(23%) 07(0.7%) 03(0.3%)	4.677	0.197	3	Non-significant
Gender Female Male	26(59.09%) 18(40.91%)	25(44.64%) 31(55.36%)	51(51%) 49(49%)	2.617	0.270	2	Non-significant
Education No formal education Primary education Secondary education High school education Graduation Post-graduation	02(04.54%) 08(18.18%) 06(13.64%) 15(34.09%) 08(18.18%) 05(11.37%)	06(10.71%) 08(14.28%) 18(32.15%) 14(25.01%) 09(16.07%) 01(01.78%)	08(08%) 16(16%) 24(24%) 29(29%) 17(17%) 06(06%)	9.456	0.092	5	Non-significant
Occupation Employed Unemployed Private job Government job	10(22.72%) 20(45.46%) 12(27.27%) 02(04.54%)	14(25.00%) 32(57.14%) 08(14.28%) 02(03.58%)	24(24%) 52(52%) 20(20%) 04(04%)	2.983	0.394	3	Non-significant
Marital status Married Unmarried Single Widow or widower	28(63.63%) 14(31.81%) 02(04.54%) 00(00.00%)	35(62.50%) 15(26.78%) 00(00.00%) 06(10.72%)	63(63%) 29(29%) 02(02%) 06(06%)	7.480	0.058	3	Non-significant
Family income Below 5000/- 5001-10,000/- 10,001-20,000/- Above 20,000/-	01(02.27%) 12(27.27%) 25(56.81%) 06(13.65%)	02(03.57%) 20(35.72%) 26(46.42%) 08(14.29%)	03(03%) 32(32%) 51(51%) 14(14%)	1.110	0.775	3	Non-significant
Type of family Joint family Nuclear family	19(43.18%) 25(56.82%)	18(32.14%) 38(67.86%)	37(37%) 63(63%)	0.895	0.344	1	Non-significant
Area of residence Rural Urban	13(29.54%) 31(70.46%)	11(19.64%) 45(80.36%)	24(24%) 76(76%)	1.325	0.250	1	Non-significant
Religion Hindu Sikh Christian	29(65.00%) 15(33.00%) 01(02.00%)	37(67.00%) 17(31.03%) 01(01.07%)	66(66%) 32(32%) 02(02%)	0.907	0.635	2	Non-significant
Lifestyle factor smoking Yes No	04(09.09%) 40(90.91%)	01(01.78%) 55(98.22%)	05(05%) 95(95%)	2.768	0.096	1	Non-significant
Lifestyle factor alcohol Yes No	06(13.63%) 38(86.37%)	04(07.14%) 52(92.86%)	10(10%) 90(90%)	1.154	0.283	1	Non-significant
Source of information regarding the DOTS treatment ASHA worker Television/radio Newspaper Health professional	01(02.27%) 00(00.00%) 00(00.00%) 43(97.73%)	12(21.43%) 01(01.78%) 03(05.36%) 40(71.42%)	13(13%) 01(01%) 03(03%) 83(83%)	11.101	0.011	3	Non-significant
Satisfaction with information received from healthcare providers regarding the importance of DOTS therapy Excellent Unsatisfactory Good	01(02.27%) 00(00.0%) 43(97.73%)	04(07.14%) 15(26.78%) 37(66.08%)	05(05%) 15(15%) 80(80%)	14.883	0.001	2	Significant
Type of cases New sputum-positive case Treatment after default Relapse	44(100.0%) 00(000.0%) 00(000.0%)	43(76.78%) 06(10.72%) 07(12.05%)	87(87%) 06(06%) 07(07%)	11.741	0.003	2	Significant
History of associated disease Hypertension Diabetes mellitus Any other specify None	01(02.27%) 00(00.00%) 00(00.00%) 43(97.73%)	02(03.57%) 08(14.28%) 05(08.92%) 41(73.23%)	03(03%) 08(08%) 05(05%) 84(84%)	12.115	0.007	3	Non-significant
Duration of the treatment 1 Month 2-3 Month 3-5 Month 6-8 Month	01(02.27%) 43(97.73%) 00(00.00%) 00(00.00%)	15(26.78%) 21(37.05%) 12(21.42%) 08(14.30%)	16(16%) 64(64%) 12(12%) 08(08%)	38.918	0.000	3	Significant
Phases of DOTS treatment Intensive phase Continuation phase	44(100.0%) 00(000.0%)	42(75.00%) 14(25.00%)	86(86%) 14(14%)	11.741	0.001	1	Significant

 

Table 7: -

Age: - The obtained p-value (p=0.197) was greater than the significant value (p>0.05). It indicates that there was no significant association between age and adherence to DOTS therapy among patients suffering from tuberculosis.

 

Gender: - The calculated p-value (p=0.270) was greater than the level of significance (p>0.05) indicates that there was no significant association between gender and adherence to tuberculosis treatment regimen.

 

Education: - The computed p-value (p=0.092) depicts that education was nonsignificant. Hence, education does not influence persons adherence to DOTS therapy.

 

Occupation: - The obtained p-value (p=0.394) indicates that employment was not associated with adherence to medication among patients suffering from tuberculosis.

 

Income per month (in Rs.): The obtained p-value (p=0.775) was greater than the significant value (p>0.05) indicates that there was no significant association between income per month (in Rs.) and adherence to DOTS therapy among subjects suffering from tuberculosis.

 

Marital status: The obtained p-value(p=0.058) was greater than the significant value (p>0.05) depicts that there was no significant association between marital status and adherence to medication among patients suffering from tuberculosis.

 

Religion: - The obtained p value (p=0.635) indicates that religion was not associated with adherence to treatment regimen as the p value was more than level of significance (p>0.05).

 

Area of residence: The computed p value (p=0.250) was greater than significant value (p>0.05) indicates that area of residence was associated with adherence to DOTS therapy among tuberculosis patients.

 

Type of family: The calculated p value (p=0.344) greater than the significant value (p>0.05) indicated that type of family was not associated with adherence to treatment regimen for the management of tuberculosis.

 

Source of information: The obtained p value (p=0.011) was greater than level of significance (p>0.05) depicts that there was no association between source of information and adherence to DOTS therapy.

 

Satisfaction with information received from health care personnel regarding importance of DOTS therapy: The computed p value (p=0.001) was less than the significant value (p>0.05) indicates that satisfaction with information received from health care personnel regarding importance of DOTS therapy influenced adherence level to medication among tuberculosis patients.

 

Type of cases: The calculated p value (p=0.003) was less than the significant value (p>0.05) indicates that type of cases adherence level to medication among tuberculosis patients.

 

History of associated diseases: Obtained p value(p=0.007) indicates that history of diseases was not associated with adherence to treatment regimen as the p value was more than level of significance (p>0.05).

 

Duration of the treatment: Obtained p value (p=0.000) was less than the significant value (p>0.05) indicates that duration of treatment affects adherence level to medication among tuberculosis patients.

 

Phases of DOTS treatment: - The computed p value (p=0.001) was less than the significant value (p>0.05) indicates that phases of DOTS treatment affect level of adherence.

 

NURSING IMPLICATIONS:

Nursing Education:

·       The nursing curriculum should be constructed to provide more extensive knowledge regarding tuberculosis and its management especially focused on DOTS therapy.

·       Nursing students should have knowledge and skills to adhere to therapy and its impact on the quality of life among tuberculosis patients.

·       Nursing educators can educate the students about tuberculosis and DOTS treatment.

 

Nursing Practice:

The findings of the study have several implications for the nursing practice.

·       There is a need to educate the patients regarding DOTS therapy.

·       It may further lead to reduced mortality and morbidity rates by improving patient adherence to DOTS therapy.

·       Nurses should be actively involved in community awareness programs to educate the public about tuberculosis and remove misconceptions related to tuberculosis and its management.

·       The nurses working in the community play a role in reducing stigma and discrimination due to tuberculosis by changing the public attitude towards patients suffering from tuberculosis.

 

Nursing Administration:

Several studies conducted at the national or state level highlighted deficiencies in terms of knowledge regarding DOTS therapy. Nurse administrators can organize in-service education programs for staff nurses and paramedical health workers.

·       Nurse administrators should organize seminars, workshops on prevention care, and management of patients suffering from TB.

·       For the patients, a Teaching program should be arranged by the sister in charge regarding diet therapy while on DOTS therapy.

·       A nurse administrator should post skilled nurses in DOTS centres.

 

Nursing Research:

·       Research can be conducted to assess the complications occurring to patients.

·       Future areas of Research also include

·       Creating awareness about the prevention of TB and

·       Reducing the stigma associated with the disease among the public in the community.

 

CONCLUSION:

The conclusions were drawn based on the findings of the research. The results showed that the majority of the subjects were non-adherence to DOTS therapy and less than half of the subjects had adherence to DOTS therapy.

 

AUTHOR CONTRIBUTION:

All the authors contribute to the work.

 

CONFLICTS OF INTEREST:

No conflict of interest.

 

ACKNOWLEDGMENT:

We sincerely thank our faculty members of Saraswati Nursing Institute, the senior medical officer DOTS center, and the subjects' cooperation despite their busy schedules. we would like to thank God almighty and our parents for being the guiding stars in our lives.

 

REFERENCES:

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Received on 18.04.2024           Modified on 05.06.2024

Accepted on 17.07.2024        © A&V Publications all right reserved