D.Cur. / Although tuberculosis is regarded as a curable disease, it still remains a health problem. The World Health Organization declared tuberculosis as a global emergency in 1993, and a global failure of health service providers to deal with the burden of tuberculosis in 1997. One of the factors that has a detrimental effect on the struggle against tuberculosis, is the fact that certain patients suffering from tuberculosis interrupt and/or stop taking their treatment before the scheduled period, thus, not adhering to their treatment. This non-compliance contributes to the increasing problem of chronic “halfcured and half-ill” patients with an increase of resistance against some of the first-linemedication. The problem with resistance is that second-line-medication must then be used. These medications are more toxic, the treatment is more expensive and takes longer, and, at the most, only half of the patients are cured. There are however other patients who comply with their treatment and complete it successfully. As a result of the above-mentioned problem the researcher has researched treatment compliance of tuberculosis within the context of the North West Province’s Southern District with the following objectives: ? to explore and describe the reasons why certain patients suffering from tuberculosis interrupt or prematurely stop their treatment; ? to explore and describe the reasons why certain patients suffering from tuberculosis comply with their treatment and complete it successfully; ? to develop and validate strategies in order to facilitate treatment compliance of the patient suffering from tuberculosis. Unstructured interviews were conducted with six patients who complied with their treatment, 11 patients who did not comply with their treatment (or defaulters), eight family members of non-compliant patients, and nine community health nurses. The following questions were asked in each respective group of participants: ? The treatment compliant patients and the defaulters were asked: “Tell me about your TB and treatment”. ? The family members were asked: “Tell me how his TB and treatment was for him”. ? The nurses were asked: “Why do you think some TB patients comply with their treatment and others are defaulters?” Interviews were recorded on tape and transcribed verbatim. Tesch’s (in Creswell, 1994:155) eight-step method of data-analysis was used in collaboration with an independent encoder to analyse the data. This research has proven that the treatment compliant patient is motivated and ready to comply with his treatment. Although the defaulter is also motivated he is not ready to comply with his treatment, because he does not accept tuberculosis as his problem nor the treatment thereof. This non-acceptance contributes to his misconceptions regarding tuberculosis and its treatment, and a negative attitude also develops towards the medicine, which becomes evident in the termination or adjustment of his treatment. The compliant patient on the other hand, within the same situation, when experiencing side effects, for example, still adheres to his treatment. Factors that contribute to the treatment compliance of the patient are: his motivation; his stage of behavioural change; the application of specific processes that will enable the patient to move from a nonready to a ready mode, where treatment compliance can be maintained; a patientcentred approach in the nurse-patient-relationship, where effective interpersonal skills are applied, where the patient is actively involved and where a member of his family is involved in the interaction process; and where cultural beliefs, stigmatisation and misconceptions with regard to tuberculosis and treatment are addressed. Strategies have been developed and validated that may enable the nurse to facilitate the patient’s treatment compliance. These strategies address the following aspects in order to promote the nurse’s knowledge and skills concerning: tuberculosis as problem and the treatment thereof; interpersonal skills within a patient-centred nursing approach; assessment of patient’s readiness to accept behavioural change within the patient’s cultural context; facilitation of the patient’s treatment compliance; facilitation of the community’s behavioural change in order to promote social support of the patient while cultural beliefs, stigmas and misconceptions are addressed.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:uj/uj:14680 |
| Date | 14 November 2008 |
| Source Sets | South African National ETD Portal |
| Detected Language | English |
| Type | Thesis |
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