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Social support systems key in treating tuberculosis in India

According to the World Health Organization, 1.4 million people worldwide died from tuberculosis (TB) in 2019. Nearly a third of those killed – 450,000 people – were in India, where the illness is a major public health threat.

A team of researchers, including those from Penn State College of Medicine, examined how interpersonal relationships and social support systems affect patients undergoing treatment for TB in western India. They found that patients who had a network of support adhered to their medication better than those who felt isolated or rejected.

The researchers conducted face-to-face interviews with 37 adult patients and found 59% of participants said they never missed a dose of their medication. This group noted the importance of emotional support and said their families’ empathy and compassion played important roles in helping them adhere to treatment.

The researchers also found that patients trusted their parents and spouses the most and confided in them throughout their treatment. Many patients leaned on these individuals for financial assistance or help with household chores and transportation.

Among those who struggled with adhering to a treatment plan, many lacked support from loved ones and oftentimes felt neglected. The researchers discovered that their support systems varied, and that in some cases, in-laws proved to be the least helpful or supportive.

According to the researchers, patients who received daily reminders about their medication were able to adhere to their treatment plans better than those who had to manage everything on their own.

“Social support is not just the mere presence of a family member or a friend, what matters is the quality of the relationship we share with that person and what are our experiences with that support system,” said lead researcher and alumnus Nirmal Ahuja, instructor of Population Health and Health Equity at Harrisburg University of Science and Technology. “These experiences benefit toward developing patient-centric intervention strategies and actions which is one of the key steps in building the TB cascade of care in India and globally.”

The median age of the surveyed participants was 32 years old, and the majority (57%) were married. Individuals understood the Hindi language and answered open-ended questions about their TB treatment and support systems.

The findings reveal that patients also benefited from informational support. Health care providers are responsible for conveying details on treatment options, medications and possible side effects. The researchers pointed out that doctors, who provided patient-centered care and delivered important information, helped participants succeed with their treatment. The findings from this study can help inform patient-centric social support interventions.

“The results demonstrate the important role that social support plays in medication adherence,” said Eugene Lengerich, a Penn State Cancer Institute researcher and professor of public health sciences. “Physicians can key into this support for their patients.”

Wenke Hwang, Kristin Sznajder,  Benjamin Fredrick; and Michael Chen from Penn State College of Medicine, Ashley Kuzmik from Penn State Ross and Carol Nese College of Nursing; Rajendra Patil from Mauli Hospital in India; and Bushra Shaikh from the National Tuberculosis Control Program of India contributed to this research.

The researchers declare no conflicts of interest or specific funding for this research.

The study appears in Global Public Health.


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