Medication adherence and public health nurses' support for patients with tuberculosis in Japan: In-depth interviews

Objective: Curing patients with tuberculosis is a major factor in decreasing the incidence of tuberculosis. Public health nurses (PHNs) are responsible for treatment of the tuberculosis patient, and it is important to implement suitable DOTS regarding the patient's lifestyle. This study aimed to describe PHNs' support of tuberculosis patients assessed to be at high risk of interruption of medication, focusing on support they provided to prevent such interruptions. Method: Thirteen PHNs working in public health centers responded to semi-structured interviews in 2008. Interviews were audiotaped, transcribed verbatim and analyzed by qualitative description. Results: All participants were women with work experience as PHNs ranging from 9 to 35 years. Four categories emerged as essential components of support provided by PHNs to tuberculosis patients at high risk for interruption of medication: (i) estimate the kind of support for continuation of medication; (ii) internalize treatment as part of patient's everyday life; (iii) prevent relapse after completion of treatment; and (iv) maintain a relationship with the patient. PHNs should ‘connect the patient to treatment as soon as possible' to prevent spread of tuberculosis. PHNs ‘help to stabilize various conditions in the patient's life as a foundation of treatment' and “prevent relapse after completion of treatment” by promoting self-reliance, encouraging rehabilitation and helping in securing a livelihood. “Maintaining the relationship with the patient” forms the underpinning of support tuberculosis patients. Conclusion: Support of tuberculosis patients by PHNs is from the perspective of addressing issues in the patient's life and working with institute staff regarding convalescence.