Tuberculosis-Related Knowledge, Practices, Perceived Stigma and Discrimination, and Adherence to Anti-Tb Medication Among Patients with Tuberculosis: A Cross-Sectional Study in Jordan

Abstract

Background: Tuberculosis knowledge, practices, adherence to treatment among patients with tuberculosis are key factors for the management of the disease.

Objectives: The objectives of the study were to assess knowledge, practices, perceived stigma and discrimination, perceived family and health workers support, perceived level of satisfaction with healthcare services, delay in diagnosis/treatment and reasons for delay, and adherence to tuberculosis medication among patients with tuberculosis in Jordan.

Methods: A cross-sectional study was conducted among patients who were under treatment for tuberculosis in Jordan in 2021. A structured questionnaire was developed, pilot tested and used for data collection.

Results: This study included a total of 452 patients with tuberculosis. About 91.4% (413/452) of patients had low to moderate overall tuberculosis-related knowledge score and 8.6% had high knowledge score. Almost two-thirds of patients (67.5%, n = 305/452) had perceived a low level of stigma, 61 (13.5%) perceived a moderate level of stigma, and 86 (19.0%) perceived a high level of stigma. About 43.6% (197/ 452) of patients with tuberculosis felt stigmatized due to their tuberculosis status. Of those, almost 64.0% (126/197) reported that such feelings inhibited them from seeking healthcare services. A total of 156 out of 452 (34.5%) patients experienced a high level of discrimination, 33 (7.3%) experienced a moderate level of discrimination, and 263 (58.2%) experienced a low level of discrimination. The majority (84.5%, 382/452) of patients with tuberculosis thought that there was a delay in diagnosis and/or treatment of TB. Overall, 36.9% (167/452) of patients were not adherent to TB medication.

Conclusion: Our study showed gaps in tuberculosis knowledge and practices, high perceived stigma and discrimination, perceived delay in diagnosis and treatment initiation, non-adherence to anti- TB medications, and difficulties in accessing TB services during COVID-19 pandemic. Efforts within the national TB control program should be made to increase public awareness about the symptoms of tuberculosis and the importance of seeking early care.

Note:

Funding Information: This publication resulted (in part) from a project supported by the International Organization for Migration.

Declaration of Interests: The authors declare that they have no known financial interests or personal relationships that could have influenced the work". 'Declarations of interest: none'.

Ethical Approval Statement: Ethical approval was obtained from the Institutional Review Board (IRB) at the Ministry of Health (MoH) on March 30th 2021 (The IRB approval No. Moh/Rec/2021/056). Informed consent was obtained from each participant. Participation remained anonymous and data were treated with confidentiality.

Keywords: Tuberculosis, knowledge, Practices, Stigma, discrimination, adherence