APPLICATION OF HEALTH BELIEF MODEL ON FACTORS CONTRIBUTING TO RELAPSE, FAILURE AND LOSS TO FOLLOW UP IN TUBERCULOSIS PATIENTS

Background: There are numerous public health and clinical consequences of incomplete TB treatment. Treatment with second-line drugs is less successful and more toxic. Relapse and treatment failure are also important problems because patients can harbor drug resistant mycobacterium tuberculosis bacilli. Objective: To explore the patients' perspective about factors associated with loss to follow up, relapse and treatment failure in tuberculosis patients based on concepts of Health Belief Model. Materials and Methods: This phenomenological study was conducted on 12 patients registered at DOTS centers, U.T. Chandigarh. Purposive sampling technique was used for data collection. A pre validated semi structured interview guide was used to collect the data. In-depth interviews were conducted. Audio recording was done following permission from the participants. Principle of redundancy was followed for data collection. Results: Based on patients' verbatim 12 themes were formulated. These were Factors contributing to relapse; Factors contributing to loss to follow up; Factors contributing to relapse; Physical problems related to disease conditions; Emotional stress; Stigma related to disease; Economic challenges; Job related challenges; Family support; Health care system related challenges; Attitude of DOTS Providers; Expectations of National Programme. Each theme was further divided in to various sub-themes to categorize the information more appropriately. Conclusion: This study has demonstrated many factors responsible for loss to follow up, treatment failure and relapse in TB patients based on Health Belief Model. This model was really beneficial and provided framework to explore the patients perspective related to loss to follow up, relapse and treatment failure in tuberculosis patients. It is concluded that although medicines were provided free of cost but side effects of medicines and pills burden were disabling factor in completion of treatment. Lack of adequate food, side-effects, pill burden of the drugs, stigma and discrimination were factors that contributed to poor TB treatment adherence in the study area.In addition to this low socio-economic status, family liabilities, awareness issues and burden of losing income from work contributed to non-compliance. Addictions, imbalanced diet, primary resistance, secondary infection and non compliance to treatment contributed to treatment failure and relapse of disease.Patients were knowledge deficit related to spread and treatment of tuberculosis.