title: Delay in seeking treatment and adherence to tuberculosis medications in Russia: a survey of patients from two clinics.
abstract: BACKGROUND
  Tuberculosis is a global problem, especially in high burden countries such as Russia, that is fueled by delay in seeking treatment and nonadherence to prescribed medications. Stigma and illness representation (a person's mental image of a specific illness) have the potential to affect treatment seeking and adherence.
  
  
  OBJECTIVE
  To describe the illness representation of tuberculosis in Russians with active pulmonary tuberculosis, and to determine if stigma and illness representation are predictors of delay in seeking treatment and adherence to tuberculosis medications.
  
  
  METHODS
  Cross-sectional, descriptive survey.
  
  
  METHODS
  Two outpatient clinics in the Vladimir Region, Russia.
  
  
  METHODS
  A total of 105 adults, 18 years and older, being treated for active pulmonary tuberculosis, and on outpatient therapy for a minimum of four weeks participated in this study.
  
  
  METHODS
  Delay was measured with a question asking length of time between onset of symptoms and appointment with a physician. Stigma was measured using the Social Impact Scale. Illness representation was measured using the Revised Illness Perception Questionnaire. Participants' outpatient medication records were reviewed for medication adherence.
  
  
  RESULTS
  Symptoms reported were not consistent with those described in the medical literature and other studies. Only four subjects suspected tuberculosis based on their symptoms; 60% believed they had other respiratory infections. Multiple regression showed that illness identity (an attribute of illness representation) (beta=0.23) was a significant predictor of delay, accounting for 29% of the variance (p=0.008); and financial insecurity (beta=-0.28) and internalized shame (beta=0.27) (measures of stigma) were both significant predictors of medication adherence, accounting for 23% of the variance (p=0.003).
  
  
  CONCLUSIONS
  Illness identity was associated with delay. Internalized shame was associated with increased medication adherence while financial insecurity was associated with decreased adherence. Results point to the need for broad, culturally specific patient, family, and community education programs.
authors.affiliation: Mennonite College of Nursing at Illinois State University, Normal, IL 61761, USA. wlwoith@ilstu.edu
authors.forename: Wendy Mann
authors.initials: WM
authors.lastname: Woith
authors.forename: Janet L
authors.initials: JL
authors.lastname: Larson
mesh_terms: D000328:Adult; D000554:Ambulatory Care Facilities; D000704:Analysis of Variance; D000995:Antitubercular Agents / Q000009:adverse effects / Q000627:therapeutic use*; D015984:Causality; D003430:Cross-Sectional Studies; D005260:Female; D006301:Health Services Needs and Demand; D006801:Humans; D008297:Male; D009013:Morale; D009042:Motivation; D015404:Nursing Methodology Research; D010349:Patient Compliance / Q000523:psychology* / Q000706:statistics & numerical data; D010353:Patient Education as Topic; D025341:Principal Component Analysis; D012044:Regression Analysis; D012426:Russia; D012648:Self Care / Q000523:psychology; D012752:Shame; D013240:Stereotyping; D011795:Surveys and Questionnaires; D013997:Time Factors; D014397:Tuberculosis, Pulmonary / Q000150:complications / Q000188:drug therapy* / Q000523:psychology*
chemical_list: D000995:Antitubercular Agents