title: Self-determination and compliance in directly observed therapy of tuberculosis treatment in the Kingdom of Lesotho.
abstract: Public health officials have created directly observed therapy, short course (DOTS) to treat tuberculosis (TB) and to guarantee that drugs are taken in the right combination and for the appropriate duration. The World Health Organization (WHO) uses supervisors (nurses, nursing assistants, and community health workers [CHWs], as well as community members and relatives), to watch the patient take his or her TB medication. This article explores the observation component of DOTS, and how DOTS supervisors enhance patients' ability to comply with TB treatment by providing enablers, education, and supportive relationships. It also explores how supervisors can achieve the balance between patients' right to self-determination and a community's need for social accountability. Social work can contribute to the efficacy of TB treatment by helping public health officials understand the importance of balancing patients' rights and society's needs in determining the allocation of program resources. The results of this study are based on data gathered from 71 researcher-administered questionnaires and 25 semi-structured interviews in seven of the Kingdom of Lesotho's 19 health service areas. It was found that by providing enablers, education, and supportive relationships, DOTS supervisors ameliorate some of the logistical problems that prevent compliance. Noncompliance for patients is often an institutional/managerial problem that denies patients access to services and resources and should not be blamed on them.
authors.affiliation: Dr.LJGeorge@verizon.net
authors.forename: Laura J
authors.initials: LJ
authors.lastname: George
mesh_terms: D000328:Adult; D003153:Community Health Services / Q000458:organization & administration*; D023801:Directly Observed Therapy; D006801:Humans; D007927:Lesotho / Q000453:epidemiology; D010348:Patient Care Team / Q000458:organization & administration*; D010349:Patient Compliance / Q000523:psychology*; D026684:Personal Autonomy; D011634:Public Health / Q000379:methods*; D012947:Social Work / Q000379:methods*; D011795:Surveys and Questionnaires; D014376:Tuberculosis / Q000188:drug therapy* / Q000453:epidemiology