폐결핵 환자의 약물이행 영향요인

Abstract

The purpose of this study is to determine the level of Knowledge of Tuberculosis, Health Literacy, Stigma, Depression, Social support, Adverse Drug Reactions, and Medication Adherence in patients with pulmonary tuberculosis, and identify influencing factors on medication adherence in patients with pulmonary tuberculosis. This is a descriptive research study that attempts to provide the basic data necessary for the development of a nursing intervention program that raises the level. This study was conducted on 132 patients diagnosed with tuberculosis and taking primary drugs at the time of the study at Seven General Hospitals in Five Cities, and collected using a structured questionnaire to those who voluntarily agreed to participate in the study.

The 111 (84%) questionnaires were retrieved, and all were finally analyzed. Data were collected from November 11, 2021 to February 12, 2022. and data was analyzed by frequency, percentage, mean and standard deviation, t-test, ANOVA, Scheffe test, Pearson's correlation coefficients, and Multiple Regression Analysis (ENTER) according to the research purpose using IBM SPSS WIN 23.0 program. The results of this research are as follows.

1. The average score of the Knowledge of tuberculosis was 19.47±5.32 points (30 points), Health literacy was 2.03±0.61 points (3 points), and Stigma was 3.22±0.81 points (5 points), which is the sub-domains Stigma I (Community perspectives toward tuberculosis) was 3.40±0.77 points, and Stigma II (Patient's perspectives toward tuberculosis) was 3.03±1.00 points. Depression was 5.72±6.22 points (27 points), Social support was 4.29±0.73 points (5 points), and which is the sub-domains, Family support was 4.18±0.93 points, and Medical staff support was 4.44±0.73 points. Averse drug reaction was 0.62±0.63 points (5 points) and Medication adherence was 1.17±0.35 points (4 points).

2. According to the Socio demographic and Disease-related characteristics of the subjects, Knowledge of tuberculosis showed significant differences in their age (F=4.20, =.017), occupation (t=-2.02, p=.047), and education level (F=5.76, p=.001). Health literacy was significantly different in their age (F=3.81, p=.025), education level (F=3.93, p=.010), and family living together (t=-2.03, p=.044). Depression had significant differences in their age (F=3.28, p=.041), gender (t=-3.07, p=.003), occupation (t=2.73, p=.008), and education level (F=8.27, p<.001), economic status (F=3.12, p=.048), smoking experience (t=2.35, p=.020), and comorbidities (t=-1.99, p=.049). In Stigma I, there were significant differences in their occupation (t=2.07, p=.041), number of alcohol (t=4.09, p=.027), and type of alcohol (t=2.20, p=.041). In Stigma Ⅱ, there were significant differences in their occupation (t=1.80, p=.005) and the number of alcohol (t=4.66, p=.017). In Social support, Family support had significant differences in their religion (t=-2.82, p=.006), marital status (F=3.78, p=.006), economic status (F=8.68, p<.001) and family living together (t=-3.23, p=.003), medications other than tuberculosis (t=-2.48, p=.015) and presence of caregivers other than medical staff (t=-3.70, p<.001). There was no statistically significant difference in the Medical staff support. Adverse drug reactions there were significant differences in gender (t=-4.85, p<.001), smoking experience (t=2.32, p=.022), and type of alcohol (t=2.87, p=.018). Medication adherence was significantly different in their age (F=3.35, p=.039), religion (t=2.18, p=.031), type of drinking (t=2.15, p=.045), duration of tuberculosis medication (t=-2.24, p=.027), diseases other than tuberculosis (t=2.31, p=.023), medications other than tuberculosis (t=2.72, p=.008), tuberculosis education (t=-2.07, p=.041).

3. As a result of correlation analysis, Health literacy and Knowledge of tuberculosis (r=.60, p<.001), Stigma Ⅰ and Stigma Ⅱ (r=.69, p<.001), Depression and Stigma Ⅰ (r=.30, p=.001), Depression and Stigma Ⅱ (r=.32, p<.001), Family support and Knowledge of tuberculosis (r=.28, p=.002), Family support and Health literacy (r =.33, p<.001), Medical staff support and Health literacy (r=.43, p<.001), Medical staff support and Family support (r=.45, p<.001), Adverse drug reactions and Depression (r=.58, p<.001), Medication adherence and Stigma II (r=.20, p=.033) were positively correlated. Depression and Knowledge of tuberculosis (r=-.26, p=.005), Family support and Stigma II (r=-.19, p=.039) showed a significant negative correlation.

4. Factors affecting the Medication adherence of subjects were age ((β=-.22, p=.033) and Stigma Ⅱ (β=.20, p=.029), and the explanatory power of the variables was 19.3%.

In conclusion, in this study, in order to increase the medication adherence of tuberculosis patients, it is necessary to consider a multi-faceted approach, including not only the physical symptoms of the patient but also the emotional aspects. In other words, it is necessary to take into account the age of tuberculosis patients or family members and manage depression or stigma through early assessment so that there are no emotional difficulties. In addition, it is thought that it is required to develop a medication adherence management program that provides practical information and management measures for rapid response to adverse drug reactions and appropriate management. In line with the patient's treatment process, a step-by-step approach, such as receiving direct active management from medical staff during the initial two- month intensive care period, and developing a systematic system for better self- management during the latter four months, will also contribute to improving the success rate of tuberculosis treatment.