title: Perspectives of Patients, Doctors and Medical Students at a Public University Hospital in Rio de Janeiro Regarding Tuberculosis and Therapeutic Adherence.
abstract: BACKGROUND
  The World Health Organization (WHO) identifies 8.7 million new cases of tuberculosis (TB) annually around the world. The unfavorable outcomes of TB treatment prevent the achievement of the WHO's cure target.
  
  
  OBJECTIVE
  To evaluate existing intersections in the conceptions relative to the knowledge of TB, the experience of the illness and the treatment.
  
  
  METHODS
  Doctors, medical students and patients were selected from a public university in Rio de Janeiro, Brazil, from 2011 to 2013. The data were obtained by semi-structured individual and focus group interviews, participant observation and a field journal. The inclusion of patients was interrupted due to saturation, and the inclusion of doctors and medical students stopped due to exhaustion. The theoretical background included symbolic Interactionism, and the analysis used rounded Theory. The analysis prioritized the actions/interactions axis.
  
  
  RESULTS
  Twenty-three patients with pulmonary TB, seven doctors and 15 medical students were included. In the interviews, themes such as stigma, self-segregation, and difficulties in assistance emerged, in addition to defense mechanisms such as denial, rationalization, isolation and other mental mechanisms, including guilt, accountability and concealment of the disease. Aspects related to the assistance strategy, the social support network, bonding with the healthcare staff and the doctor-patient relationship were highlighted as adherence enablers. Doctors and students recommended an expansion of the theoretical and practical instruction on TB during medical students' education. The existence of health programs and policies was mentioned as a potential enabler of adherence.
  
  
  CONCLUSIONS
  The main concepts identified were the stigma, self-segregation, guilt, responsibility, concealment and emotional repercussions. In relation to the facilitation of therapeutic adherence, the concepts identified were the bonds with healthcare staff, the doctor-patient relationship, assistance and educational health strategies.
authors.affiliation: National Institute of Infectious Diseases Evandro Chagas (INI/Fiocruz), Rio de Janeiro, Brazil.
authors.forename: Elizabeth da Trindade
authors.initials: Eda T
authors.lastname: de Andrade
authors.affiliation: National Institute of Infectious Diseases Evandro Chagas (INI/Fiocruz), Rio de Janeiro, Brazil; Deputy Direction of Education, National Institute of Infectious Diseases Evandro Chagas (INI/Fiocruz), Rio de Janeiro, Brazil.
authors.forename: Élida Azevedo
authors.initials: ÉA
authors.lastname: Hennington
authors.affiliation: Faculty of Medical Sciences, State University of Rio de Janeiro (UERJ), Rio de Janeiro, Brazil.
authors.forename: Hélio Ribeiro de
authors.initials: HR
authors.lastname: Siqueira
authors.affiliation: National Institute of Infectious Diseases Evandro Chagas (INI/Fiocruz), Rio de Janeiro, Brazil; Clinical Research Laboratory on Mycobacteria, National Institute of Infectious Diseases Evandro Chagas (INI/Fiocruz), Rio de Janeiro, Brazil.
authors.forename: Valeria Cavalcanti
authors.initials: VC
authors.lastname: Rolla
authors.affiliation: National Institute of Infectious Diseases Evandro Chagas (INI/Fiocruz), Rio de Janeiro, Brazil; Deputy Direction of Education, National Institute of Infectious Diseases Evandro Chagas (INI/Fiocruz), Rio de Janeiro, Brazil.
authors.forename: Celina
authors.initials: C
authors.lastname: Mannarino
mesh_terms: D001938:Brazil; D005260:Female; D019983:Guideline Adherence; D007722:Health Knowledge, Attitudes, Practice; D020445:Hospitalists / Q000523:psychology; D006779:Hospitals, Public / Q000592:standards / Q000706:statistics & numerical data*; D006785:Hospitals, University / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans; D010361:Patients / Q000523:psychology; D013240:Stereotyping; D013337:Students, Medical / Q000523:psychology; D014397:Tuberculosis, Pulmonary / Q000453:epidemiology / Q000523:psychology* / Q000628:therapy