背景：抗结核治疗的谈判是一个复杂的过程，包括每天在规定的时间和剂量下服用多种药物，以及定期跟进和调查，可能并非所有结核病（TB）患者都是统一的，有些患者可能比其他患者表现更好。在这种情况下，我们在Thiruvananthapuram区进行了一项研究,喀拉拉邦确定结核病患者遵循治疗指南的能力。
方法：本研究采用嵌入式混合方法设计。我们收集了Thiruvananthapuram的135名18岁或以上的药物敏感性肺结核患者的横断面数据，喀拉拉邦使用结构化问卷来获取遵循所有治疗指南的患者比例。我们还从调查样本中进行了八次深入访谈（四名男性和四名女性）。对深入访谈进行了归纳分析，以更深入地了解人们对治疗指南做出选择的原因。所有参与者均获得书面知情同意书，并在必要的计划和道德许可后实施研究。
结果：在所研究的105名男性和30名女性中，80人报告每日不间断的药物消费(59.3%，95%置信区间（CI）50.8-67.2%）。总的来说,38（28.2%，95％CI21.3％-36.3％）的人能够遵循建议的指南的所有七个方面。生活在一个大家庭/联合家庭(调整后赔率(AOR)2.6，95%CI1.1-6.0)，大约每月超过卢比的家庭支出13,500(AOR2.9,95%CI1.3-6.7)和没有感知到的寻求初始护理延迟(AOR3.2,95%CI1.2-8.7)与遵循治疗指南的所有方面显著相关.深入访谈显示，与反思性治疗相关的行为受到身体体验的影响，道德观念，结核病的社会建构，方案因素和物质使用。有时行为也是非反思的。程序压力是改变行为的个人机构，但这些能力和机会受到社会方面的影响，如污名，性别角色和贫困。
结论：结核病患者生活在生物医学和社会问题的共同背景下。这些问题影响了此类结核病患者遵循治疗指南的能力和机会。干预措施应平衡对个人机构和社会和经济因素的关注。
Negotiating anti-Tuberculosis treatment is a complicated process comprising daily consumption of multiple medications at stipulated times and dosages, as well as periodic follow-ups and investigations, may not be uniform for all Tuberculosis (TB) patients and some may perform better than others. In this context, we conducted a study in Thiruvananthapuram district, Kerala to ascertain the ability of those suffering from TB to follow treatment guidelines.
This study used an embedded mixed methods design. We collected cross-sectional data from 135 drug sensitive pulmonary TB patients aged 18 years or above in Thiruvananthapuram, Kerala using a structured questionnaire to get the proportion of patients following all treatment
guidelines. We also did eight in-depth interviews (four men and four women) from within the survey sample. The in-depth interviews were inductively analysed for getting deeper insights about reasons for the choices people made regarding the treatment
guidelines. Written informed consent was taken from all participants and the study was implemented after the necessary programmatic and ethical clearances.
Of the 105 men and 30 women studied, uninterrupted daily drug consumption was reported by 80 persons (59.3%, 95% Confidence Intervals (CI) 50.8-67.2%). Overall, 38 (28.2%, 95% CI 21.3%-36.3%) persons were able to follow all seven aspects of advised
guidelines. Living in an extended/ joint family (Adjusted Odds ratio (AOR) 2.6, 95% CI 1.1-6.0), approximate monthly household expenditure of over rupees 13,500 (AOR 2.9, 95% CI 1.3-6.7) and no perceived delay in seeking initial care (AOR 3.2, 95% CI 1.2-8.7) were significantly associated with following all aspects of treatment
guidelines. In-depth interviews revealed reflective treatment related behaviours were influenced by bodily experiences, moral perceptions, social construct of TB, programmatic factors and substance use. Sometimes behaviours were non-reflective also. Programmatic stress was on individual agency for changing behaviour but capability and opportunity for these were influenced social aspects like stigma, gender roles and poverty.
TB patients live amidst a syndemic of biomedical and social problems. These problems influence the capabilities and opportunities of such TB patients to follow treatment
guidelines. Interventions should balance focus on individual agency and social abd economic factors.
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