Volume 98, Issue 1
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



Medication nonadherence is common among tuberculosis (TB) patients in China and is of great concern. Herein, we determined the incidence of nonadherence in TB patients in central China and the impact of stigma and depressive symptoms on adherence; these issues are relatively unexplored. A cross-sectional survey was performed, and 1,342 TB patients were recruited from TB dispensaries in three counties in Hubei province using a multistage sampling method. The patients completed structured questionnaires that addressed medication adherence, TB-related stigma, and depressive symptoms. The independent effects of stigma and depressive symptoms on adherence were determined via multinomial logistic regression analysis. The mean medication adherence score was 6.03 ± 1.99. The percentage of TB patients with high, medium, and low medication adherence was 32.12%, 34.58%, and 33.31%, respectively. The impact of stigma and depressive symptoms on medication adherence was significant. TB patients with medium (odds ratios [OR]: 1.54, 95% confidence interval [CI]: 1.08–2.21) or high (OR: 5.32, 95% CI: 3.34–8.46) stigma or patients with mild (OR: 1.92, 95% CI: 1.34–2.75) or severe (OR: 3.67, 95% CI: 2.04–6.61) depressive symptoms showed a higher likelihood of having low adherence than those with low stigma or without depressive symptoms. TB-related stigma and depressive symptoms were common among TB patients in China, as was nonadherence, and independently associated with their adherence behavior. Social and psychological interventions that combat stigmatization and depression in TB patients should be adopted and optimized to improve medication adherence.


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  1. World Health Organization, 2016. Global Tuberculosis Report 2016. Geneva, Switzerland: WHO.
  2. Wang Y, , 2011. Report of the Fifth National Tuberculosis Epidemiological Survey. Beijing, China: Military Medical Science Press.
  3. Yin X, 2012. Development and validation of a tuberculosis medication adherence scale. PLoS One 7: e50328. [Google Scholar]
  4. Gordillo V, del Amo J, Soriano V, Gonzalez-Lahoz J, , 1999. Sociodemographic and psychological variables influencing adherence to antiretroviral therapy. AIDS 13: 17631769. [Google Scholar]
  5. DiMatteo MR, , 2004. Social support and patient adherence to medical treatment: a meta-analysis. Health Psychol 23: 207218. [Google Scholar]
  6. Tang Y, 2015. Non-adherence to anti-tuberculosis treatment among internal migrants with pulmonary tuberculosis in Shenzhen, China: a cross-sectional study. BMC Public Health 15: 474. [Google Scholar]
  7. Wang PS, Bohn RL, Knight E, Glynn RJ, Mogun H, Avorn J, , 2002. Noncompliance with antihypertensive medications: the impact of depressive symptoms and psychosocial factors. J Gen Intern Med 17: 504511. [Google Scholar]
  8. Weiser S, 2003. Barriers to antiretroviral adherence for patients living with HIV infection and AIDS in Botswana. J Acquir Immune Defic Syndr 34: 281288. [Google Scholar]
  9. Masumoto S, Yamamoto T, Ohkado A, Yoshimatsu S, Querri AG, Kamiya Y, , 2014. Prevalence and associated factors of depressive state among pulmonary tuberculosis patients in Manila, The Philippines. Int J Tuberc Lung Dis 18: 174179. [Google Scholar]
  10. Kehbila J, Ekabe CJ, Aminde LN, Noubiap JJ, Fon PN, Monekosso GL, , 2016. Prevalence and correlates of depressive symptoms in adult patients with pulmonary tuberculosis in the southwest region of Cameroon. Infect Dis Poverty 5: 51. [Google Scholar]
  11. Dodor EA, Kelly SJ, , 2010. Manifestations of tuberculosis stigma within the healthcare system: the case of Sekondi-Takoradi Metropolitan district in Ghana. Health policy (Amsterdam, Netherlands) 98: 195202. [Google Scholar]
  12. Abebe G, 2010. Knowledge, health seeking behavior and perceived stigma towards tuberculosis among tuberculosis suspects in a rural community in southwest Ethiopia. PLoS One 5: e13339. [Google Scholar]
  13. Morisky DE, Ang A, Krousel-Wood M, Ward HJ, , 2008. Predictive validity of a medication adherence measure in an outpatient setting. J Clin Hypertens (Greenwich) 10: 348354. [Google Scholar]
  14. Yan J, You LM, Yang Q, Liu B, Jin S, Zhou J, Lin C, Morisky DE, , 2014. Translation and validation of a Chinese version of the 8-item Morisky medication adherence scale in myocardial infarction patients. J Eval Clin Pract 20: 311317. [Google Scholar]
  15. Yang TT, Tong YQ, Yin XX, Lu ZX, Gong YH, , 2016. Evaluation of morisky medication aherence scale and family APGAR applied to patients with tuberculosis. Chinese Journal of Social Medicine 33: 580582. [Google Scholar]
  16. Yang TT, Gong YH, Yin XX, Lu ZX, Tong YQ, , 2016. Development and validation of a tuberculosis-related stigma scale. Journal of Pubic Health and Preventive Medicine 27: 4648. [Google Scholar]
  17. Smilkstein G, , 1978. The family APGAR: a proposal for a family function test and its use by physicians. J Fam Pract 6: 12311239. [Google Scholar]
  18. Nan H, Lee PH, Ni MY, Chan BH, Lam TH, , 2013. Effects of depressive symptoms and family satisfaction on health related quality of life: the Hong Kong family study. PLoS One 8: e58436. [Google Scholar]
  19. Zhang SY, Bai LQ, Tan HZ, Yang HL, , 2010. Application of the morisky medication adherence scale on pulmonary tuberculosis patients. Chinese Journal of Antituberculosis 32: 527530. [Google Scholar]
  20. Wang XH, , 2013. Study on Medication Adherence and Its Determinants among Pulmonary Tuberculosis Patients of Shandong Province. School of Public Health. Jinan, China: Shandong University, 20.
  21. Meulemans H, Mortelmans D, Liefooghe R, Mertens P, Zaidi SA, Solangi MF, De Muynck A, , 2002. The limits to patient compliance with directly observed therapy for tuberculosis: a socio-medical study in Pakistan. Int J Health Plann Manage 17: 249267. [Google Scholar]
  22. Ansari S, Mulla S, , 2014. Analysis of variables affecting drug compliance in schizophrenia. Ind Psychiatry J 23: 5860. [Google Scholar]
  23. Vrbova K, Kamaradova D, Latalova K, Ociskova M, Prasko J, Mainerova B, Cinculova A, Kubinek R, Tichackova A, , 2014. Self-stigma and adherence to medication in patients with psychotic disorders–cross-sectional study. Neuroendocrinol Lett 35: 645652. [Google Scholar]
  24. Singh N, Squier C, Sivek C, Wagener M, Nguyen MH, Yu VL, , 1996. Determinants of compliance with antiretroviral therapy in patients with human immunodeficiency virus: prospective assessment with implications for enhancing compliance. AIDS Care 8: 261269. [Google Scholar]
  25. Kiley DJ, Lam CS, Pollak R, , 1993. A study of treatment compliance following kidney transplantation. Transplantation 55: 5156. [Google Scholar]
  26. Kastien-Hilka T, Rosenkranz B, Bennett B, Sinanovic E, Schwenkglenks M, , 2016. How to evaluate health-related quality of life and its association with medication adherence in pulmonary tuberculosis–designing a Prospective Observational Study in South Africa. Front Pharmacol 7: 125. [Google Scholar]

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  • Received : 16 May 2017
  • Accepted : 31 Aug 2017
  • Published online : 30 Oct 2017

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