Predictors of medication adherence in people hospitalised with tuberculosis: utility of the Health Belief Model
| dc.contributor.advisor | Kagee, Ashraf | en_ZA |
| dc.contributor.author | Rynhoud, Leigh | en_ZA |
| dc.contributor.other | Stellenbosch University. Faculty of Arts and Social Sciences. Dept. of Psychology. | en_ZA |
| dc.date.accessioned | 2021-10-26T20:23:35Z | en_ZA |
| dc.date.accessioned | 2022-02-22T10:15:38Z | en_ZA |
| dc.date.available | 2022-02-23T03:00:14Z | en_ZA |
| dc.date.issued | 2021-12 | en_ZA |
| dc.description | Thesis (PhD)--Stellenbosch University, 2021 | en_ZA |
| dc.description.abstract | ENGLISH ABSTRACT: The purpose of this study was to explore the utility of the Health Belief Model (HBM) to predict adherence to treatment for tuberculosis. The first aim was to develop an appropriate, and freely available instrument to measure tuberculosis medication-taking behaviour. The final scale consisted of four self-reported questions, and one question based on information obtained from reports made by health care-providers. I named this scale the Tuberculosis Adherence Scale (TB-AS). The Cronbach’s alpha calculated for TB-AS was 0.69. The second aim of this study was to construct a questionnaire based on the HBM specific to adherence to tuberculosis medication. I administered the HBM measure to 205 participants. Following an item analysis and exploratory factor analysis, 41 items were retained, and five subscales were extracted. I named the subscales Perceived Threat, Perceived Benefits, Perceived Barriers, Self-Efficacy and Cues to Action. I named the questionnaire the Tuberculosis Health Belief Scale (TB-HBS). The TB-HBS demonstrated excellent internal consistency and produced a Cronbach’s alpha of 0.87. The Cronbach’s alpha for each subscale ranged from 0.72 to 0.81. The final aim of the study was to explore the utility of the HBM and additional variables to predict adherence to tuberculosis treatment. I used a cross sectional design and 175 participants who were hospitalised at two specialised tuberculosis hospitals in the Western Cape, South Africa were recruited. Adherence was measured using the TB-AS, health beliefs using the TB-HBS and beliefs about medicine evaluated by the Beliefs about Medicine Questionnaire, Alcohol use, drug use and depression were assessed using the Alcohol Use Disorders Identification Test, Drug Use Disorder Identification Test and Beck Depression Inventory respectively. The results obtained from the TB-AS indicated that 33.1% of participants had low adherence, 34.3% had medium adherence and 32.5% of participants had high adherence. The HBM factors did not significantly predict adherence and explained an additional 2% of variance when included in the regression analysis. Older age [ = 0.24, t (158) = 3.37, p < 0.01], full time occupation [ = 0.18, t (158) = 2.47, p = 0.01], high belief in the general harm of medication [ = 0.20, t (158) = 2.07, p = 0.04], fewer specific concerns about tuberculosis treatment [ = -0.04, t (158) = -2.11, p = 0.04], lower alcohol use [ = -0.20, t (158) = -2.76, p = 0.01], fewer symptoms of depression [ = -0.16, t (158) = -2.09, p = 0.04] significantly predicted improved adherence to treatment for tuberculosis. The results of the regression analysis indicated that the model explained 21% of the variance in adherence (adj R2 =0.21, F (3, 158) = 5.12, p< 0.01) yielding a moderate effect size (ƒ2 = 0.27). The TB-HBS and the TB-AS showed promise as reliable tools to measure health beliefs and adherence to treatment, respectively. The findings suggest that the HBM may not be an appropriate theoretical model to predict adherence to treatment in this context. Further research is recommended to explore the complex and interacting dimensions that affect adherence to tuberculosis treatment. | en_ZA |
| dc.description.abstract | AFRIKAANS OPSOMMING: Die doel van hierdie studie was om die nut van die Gesondheidsoortuigingsmodel (GOM) te ondersoek om die nakoming van behandeling vir tuberkulose te voorspel. Die eerste doelstelling was om 'n toepaslike, en vrylik beskikbare instrument te ontwikkel om tuberkulose medikasie gebruik gedrag te meet. Die finale skaal het bestaan uit vier self-gerapporteerde vrae en een vraag gebaseer op inligting wat verkry is uit gesondheidsorgverskaffers se verslae. Hierdie skaal word voorts genoem die Tuberculosis Adherence Scale (TB-AS). Die Cronbach’s alpha, vir die TB-AS was 0.69. Die tweede doelstelling was om 'n GOM gebaseerder vraelys op te stel, toegespits op tuberkulose medikasie nakoming. Die GOM-meting is op 205 deelnemers toegepas. Na 'n item ontleding en verkennende faktorontleding was 41 items behou en vyf subskale onttrek. Die subskale word voorts genoem Perceived Threat, Perceived Benefits, Perceived Barriers, Self- Efficacy en Cues to Action en die vraelys die Tuberculosis Health Belief Scale (TB-HBS). Die TB-HBS het uitstekende interne konsekwentheid getoon en 'n Cronbach’s alpha van 0.87 opgelewer. Die Cronbach’s alpha vir elke subskaal het gewissel van 0.72 tot 0.81. Die finale doel van die studie was om die nut van die GOM en addisionele veranderlikes te ondersoek om die nakoming van tuberkulose-behandeling te voorspel. 'n Deursnee-ontwerp is gebruik en 175 gehospitaliseerde deelnemers, in twee gespesialiseerde tuberkulose-hospitale in die Wes-Kaap, Suid-Afrika was gewerf. Nakoming is gemeet met behulp van die TB-AS, gesondheidsoortuigings met behulp van die TB-HBS en oortuigings oor medisyne met behulp van die BMQ. Alkoholgebruik, dwelmgebruik en depressie was geëvalueer aan die hand van die AUDIT, DUDIT en BDI. Die TB-AS resultate het gedui op lae nakoming onder 33.1% van die deelnemers, 34.3% medium nakoming en 32.5% hoë nakoming. Die GOM-faktore het nakoming nie beduidend voorspel nie en het 'n bykomende 2% variansie aangedui toe dit in die regressie-analise ingesluit was. Ouer ouderdom [ β = 0.24, t (158) = 3.37, p < 0.01], voltydse beroep [β = 0.18, t (158) = 2.47, p = 0.01], hoë vertroue in algemene skade berokken deur medikasie [β = 0.20, t (158) = 2.07, p = 0.04], minder spesifieke kommer oor tuberkulose-behandeling [ β = -0.04, t (158) = - 2.11, p = 0.04], laer alkoholgebruik [ β = -0.20, t (158) = -2.76, p = 0.01], minder depressie simptome [β = -0.16, t (158) = -2.09, p = 0.04] het die nakoming van die behandeling vir tuberkulose beduidend voorspel. Die resultate van die regressie-analise het aangedui dat die finale model 'n statisties beduidende 21% van die variansie in nakoming uitmaak (adj R² =0.21, F (3, 158) = 5.12, p< 0.01) wat 'n groot effekgrootte lewer (ƒ² = 0.27). Die TB-HBS en die TB-AS het belofte getoon as betroubare instrumente om onderskeidelik gesondheidsoortuigings en die nakoming van die behandeling te meet. Die bevindinge dui daarop dat die GOM moontlik nie 'n toepaslike teoretiese model is om die nakoming van behandeling in hierdie konteks te voorspel nie. Verdere navorsing word aanbeveel om die ingewikkelde en interaktiewe dimensies, wat die nakoming van die behandeling van tuberkulose beïnvloed, te ondersoek. | af_ZA |
| dc.description.version | Doctorate | en_ZA |
| dc.embargo.terms | 2021-12-30 | en_ZA |
| dc.format.extent | xvii, 213 pages : illustrations | en_ZA |
| dc.identifier.uri | http://hdl.handle.net/10019.1/124196 | en_ZA |
| dc.language.iso | en_ZA | en_ZA |
| dc.rights.holder | Stellenbosch : Stellenbosch University, 2021 | en_ZA |
| dc.rights.holder | Stellenbosch University | en_ZA |
| dc.subject | Health Belief Model | en_ZA |
| dc.subject | Patient compliance | en_ZA |
| dc.subject | Tuberculosis -- Patients | en_ZA |
| dc.subject | Medical care -- Utilization | en_ZA |
| dc.subject | UCTD | en_ZA |
| dc.title | Predictors of medication adherence in people hospitalised with tuberculosis: utility of the Health Belief Model | en_ZA |
| dc.type | Thesis | en_ZA |