Abstract
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.