Patient experiences and perceptions of non-compliance with TB treatment

• Main Author: Shasha, Alethea Christina N.
• Other Authors: Eygelaar, Elsa
• Format: Others
• Language: en_ZA
• Published: Stellenbosch : Stellenbosch University 2013
• Subjects: Tuberculosis > Treatment; Interrupted TB treatment; Dissertations > Nursing; Theses > Nursing
• Online Access: http://hdl.handle.net/10019.1/80314

Thesis (MCurr)--Stellenbosch University, 2013. === ENGLISH ABSTRACT: Non-compliance with (tuberculosis) TB treatment is a problem at the Nyanga Clinic in the Western Cape Province. Non-compliance is defined as when a patient interrupted TB treatment for more than two months consecutively, at any time during the treatment period. The aim of the study was to explore the patient experiences and perceptions of non-compliance regarding their TB treatment. The following research question was posed by the researcher as a guide for this study: “What are the patient experiences and perceptions of non-compliance with TB treatment?” The objectives of this study were to determine the: - patients’ experiences and perceptions of non-compliance with TB treatment - non-compliant patients’ knowledge regarding TB - reasons why patients are not compliant with TB treatment. A qualitative, explorative, descriptive and contextual design was applied. The target population included the 354 non-compliant with TB treatment patients from March 2010 until May 2011. A purposive, non-random sampling technique was used to select participants for the study. Every tenth participant who, according to the TB register, was colour-coded as non-compliant with TB treatment, was selected for interviewing until data saturation should occurred. A sample of fourteen (14) participants was realised. A semi-structured interview schedule was developed based on the objectives of the study, which was validated by experts in nursing and approved by the Human Resources Ethics Committee of the Faculty of Health Sciences of the University of Stellenbosch. Data was collected personally by the researcher. Informed written consent was obtained from the participants. One patient who was not included in the main study was selected at random to pre-test the semi-structured interview. The pilot study revealed no pitfalls. Trustworthiness of the research was enhanced by adhering to the principles of credibility, confirmability, transferability and dependability. Credibility was ensured by member checking, data saturation, triangulation and involvement of an experienced research supervisor. Confirmability was enhanced through member checking and the leaving of an audit trail. Transferability through keeping an intensive description of all the processes and dependability by using an interview schedule and by submitting the transcribed tape-recorded data and field notes to the research supervisor for verification. The quantitative data was summarised in a table format to enhance clarity and facilitate a rapid overview of the results. The qualitative data was analysed manually with the findings coded and divided into subthemes and themes. Four themes emerged, namely: health system, client-related, social-economic and therapy factors. These themes identified the impeding factors regarding the non-compliance with TB treatment. The main conclusion is that there is a need to educate the community regarding the lengthy duration of the TB treatment, its side-effects, its curability and the spread of the infection as well as the consequences of inadequate treatment to empower the community at large about the disease. The National Department of Health framework of contributing to non-compliance with TB treatment was used as the conceptual framework for this study. The researcher applied the problem-solving approach of Faye Glen Abdellah’s theory. According to this theory it is anticipated that by solving the problems or needs of patients, through appropriate and organised health strategies the client will be moved towards ultimate health. === AFRIKAANSE OPSOMMING: Onderbreking van tuberkulose (TB) behandeling is ’n probleem by die Nyanga-kliniek in die Wes-Kaap Provinsie. Onderbreking kan gedefinieer word wanneer’n pasiënt vir twee of drie opeenvolgende maande TB behandeling onderbreek het (Jaggarajamma, Sudha, Chandrasekaran, Nirupa, Thomas, Santha, Muniyandi & Narayanan, 2007:131). Die doel van die studie is om die pasiënte se ervaringe en persepsies betreffende die onderbreking in TB behandeling te ondersoek. Die navorser het die volgende navorsingsvraag as riglyn vir hierdie studie gestel: “Wat is die pasiënte se ervaringe en persepsies wat TB-behandeling onderbreek het?” Die doelwitte van die studie was om te bepaal wat die: - pasiëntervaringe en persepsies is wat TB-behandeling onderbreek - kennis van pasiënte is wat TB-behandeling onderbreek - redes is waarom pasiënte TB-behandeling onderbreek. ’n Kwalitatiewe navorsingsontwerp met’n ondersoekende, beskrywende en kontekstuele benadering is aangewend. ’n Doelbewuste, lukrake steekproef is gebruik om deelnemers te selekteer. ‘n Steekproef van veertien (14) deelnemers uit ’n totale populasie van 354 hetrealiseer en sluit pasiënte in wat behandeling onderbreek het vanaf Maart 2010 tot en met Mei 2011. ’n Semi-gestruktureerde onderhoudsgids is ontwerp, gebaseer op die doelwitte van die studie en gevalideer deur kundiges in verpleegkunde en die Etiese Komitee van die Fakulteit van Gesondheidswetenskappe aan die Universiteit van Stellenbosch. Die data is persoonlik deur die navorser ingesamel. Ingeligte skriftelike toestemming is van die deelnemers verkry. Een deelnemer wat nie ingesluit is by die hoofstudie nie, is lukraak gekies om die semi-gestruktureerde onderhoud te toets. Die loodsondersoek het geen tekortkominge aangedui nie. Betroubaarheid van die studie is verseker deur die beginsels van objektiwiteit, bevestiging, veralgemening en neutraliteit te verseker. Getranskribeerde data is gekontroleer met die deelnemers, volledige beskrywings van alle prosesse is bygehou, ’n onderhoudsgids is gebruik om te verseker dat vir al die deelnemers dieselfde vrae gevra word, en ’n ervare navorsing toesighouers was deurgaans teenwoordig wat alle data gevalideer het. Kwantitatiewe data is in ’n tabel opgesom ten einde goeie oorsig te bied. Kwalitatiewe data-analise is met die hand gedoen. Die data wat uit die analise na vore gekom het, is geënkodeer en in subtemas en temasgekategoriseer. Die vier temas wat hieruit voortspruit, is faktore betreffende die gesondheidsorgsisteem, kliënte, sosio-ekonomiese en terapie-verwante faktore. Die navorser het n geskrewe verslag saamgestel betreffende die weergawe van die data-analise ten einde te verseker dat belangrike data nie verlore gaan. Die belangrikste bevindinge van die studie dui daarop dat die gemeenskap ’n behoefte aan opleiding het betreffende die onderbreking in TB behandeling, die langdurige tydperk van behandeling, newe-effekte van die medikasie, geneesbaarheid daarvan, hoe die siekte versprei en die gevolge betreffende onvoldoende medikasie ten einde die gemeenskap te bemagtig betreffende die siekte. Die raamwerk van die Nasionale Departement van Gesondheid (2009:45) betreffende die faktore wat bydra tot onderbreking in TB-behandeling is gebruik as konseptuele raamwerk vir die studie. Faye Abdellah se teorie (George, 2002:173-1830)verduidelik verpleging as ’n omvattende diens wat insluit: identifisering van die pasiënt se verplegingsprobleme, die besluit van ’n toepaslike plan van aksie, sowel as die voortgesette sorg betreffende die individu se totale behoeftes.