Association between Medication Adherence, Anxiety, and Quality of Life in Pulmonary Tuberculosis Patients: A Cross-Sectional Study

Gelmeyfia; Tika Afriani; Miftahul Jannah

doi:10.35451/wpk19m04

Authors

Gelmeyfia Program Studi Farmasi, Fakultas Ilmu Kesehatan, Universitas Mohammad Natsir Bukittinggi
Tika Afriani Program Studi Farmasi, Fakultas Ilmu Kesehatan, Universitas Mohammad Natsir Bukittinggi
Miftahul Jannah Program Studi Farmasi, Fakultas Ilmu Kesehatan, Universitas Mohammad Natsir Bukittinggi

DOI:

https://doi.org/10.35451/wpk19m04

Keywords:

Quality Of Life , Tuberculosis, Medication Adherence, Anxiety

Abstract

Background: Tuberculosis (TB) remains a major public health problem in Indonesia with a high disease burden. Treatment success is strongly influenced by medication adherence; however, psychological factors such as anxiety and aspects of quality of life often interact in complex ways and have not been extensively examined simultaneously, particularly in primary healthcare settings. Objective: This study aimed to analyze the relationship between medication adherence, anxiety levels, and quality of life among patients with pulmonary tuberculosis. Methods: A quantitative analytic study with a cross-sectional design was conducted among 107 pulmonary TB patients using a total sampling technique. Variables were measured using standardized instruments, including the MMAS-8, GAD-7, and WHOQOL-BREF. Data were analyzed using Spearman’s rank correlation test. Results: Most respondents demonstrated a moderate level of medication adherence (62.6%), with anxiety predominantly at a minimal level (98.1%). Correlation analysis revealed a strong negative relationship between adherence and anxiety (rₛ = −0.729; p < 0.001), indicating that higher adherence is associated with lower anxiety levels. Furthermore, adherence was significantly positively associated with quality of life in the psychological (rₛ = 0.454; p < 0.001), social (rₛ = 0.461; p < 0.001), and environmental domains (rₛ = 0.600; p < 0.001), but not in the physical domain (p = 0.058). Conclusion: These findings highlight that medication adherence plays an important role not only in clinical outcomes but also in patients’ psychological well-being and quality of life. Integrating adherence-based interventions with psychosocial approaches is essential to improve treatment outcomes holistically.

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References

[1] Simamora ND, Nurani IA. Analisis Asuhan Keperawatan Melalui Intervensi Terapi Tehnik Relaksasi Benzon Pada Keluarga Dengan Tb Paru Di Kelurahan Lenteng Agung Jakarta Selatan. J Pengabdi Masy Nas 2023;1. https://doi.org/10.47313/jpmn.v1i2.2674.

[2] Hariadi E, Buston E, Nugroho N, Efendi P. Analisis Asuhan Keperawatan Melalui Intervensi Terapi Tehnik Relaksasi Benzon Pada Keluarga Dengan Tb Paru Di Kelurahan Lenteng Agung Jakarta Selatan Stigma Masyarakat Terhadap Penyakit Tuberkulosis Dengan Penemuan Kasus Tuberkulosis Bta Positif Di Kota B. J Nurs Public Heal 2023;11. https://doi.org/10.37676/jnph.v11i1.4080.

[3] WHO. Global Report TB 2023. January 2023;t/TB/.

[4] Kementerian Kesehatan Republik Indonesia. Profil Kesehatan Indonesia Tahun 2024. Jakarta: 2024.

[5] Dinkes Prov R. Profil Kesehatan Provinsi Riau 2022. Dinkes Profinsi Riau 2022.

[6] Kemenkes RI. Strategi Komunikasi TOSS TBC (Temuan Tuberkulosis Obati Sampai Sembuh). vol. 7. 2021.

[7] Nurhayati A, Rahayuningsih N, Alifiar I. Analisis Kualitas Hidup (QoLY) dan Kepatuhan Terapi pada Pasien Tuberkulosis Paru di Rumah Sakit X Kota Tasikmalaya. Anal Kualitas Hidup … J Pharmacopolium 2020;3:183–9.

[8] Azalla CR, Maidar, Ismail N. Analisis Kualitas Hidup Penderita Tuberkulosis Paru terhadap Kepatuhan Pengobatan Tuberkulosis di Wilayah Kabupaten Pidie Jaya Tahun 2020. J Aceh Med 2020;14:122–36.

[9] Laghousi D, Rezaie F, Alizadeh M, Jafarabadi MA. The eight-item Morisky Medication Adherence Scale: Validation of its Persian version in diabetic adults. Casp J Intern Med 2021;12:77–83. https://doi.org/10.22088/cjim.12.1.77.

[10] Merino-Soto C, Angulo-Ramos M, Rovira-Millán L V, Rosario-Hernández E. Psychometric properties of the generalized anxiety disorder-7 (GAD-7) in a sample of workers. Front Psychiatry 2023;14:999242. https://doi.org/10.3389/fpsyt.2023.999242.

[11] Huaman MA, Ticona E, Miranda G, Kryscio RJ, Mugruza R, Aranda E, et al. The Relationship Between Latent Tuberculosis Infection and Acute Myocardial Infarction. Clin Infect Dis 2018;66:886–92. https://doi.org/10.1093/CID/CIX910.

[12] Khoufi EA Al. Association between latent tuberculosis and ischemic heart disease: a hospital-based cross-sectional study from Saudi Arabia. Pan Afr Med J 2021;38. https://doi.org/10.11604/PAMJ.2021.38.362.28110.

[13] He M, Yang X, Zhang Z, Liu Z. Impaired pulmonary function and associated factors in the elderly with tuberculosis on admission: a preliminary report. BMC Infect Dis 2023;23. https://doi.org/10.1186/S12879-023-08183-2.

[14] Hikone M, Ainoda Y, Sakamoto N, Ohnishi K. Clinical characteristics of elderly pulmonary tuberculosis in an acute-care general hospital in Tokyo, Japan: A 12-year retrospective study. J Infect Chemother 2020;26:245–50. https://doi.org/10.1016/j.jiac.2019.09.009.

[15] Ahmad N, Baharom M, Aizuddin AN, Ramli R. Sex-related differences in smear-positive pulmonary tuberculosis patients in Kuala Lumpur, Malaysia: Prevalence and associated factors. PLoS One 2021;16:e0245304.

[16] Boualam A, Touil D, Soufiani A, Chaib A, Chaib Y, El anssari A, et al. Pulmonary and extrapulmonary tuberculosis in Sidi Kacem province: A study conducted on 1506 patients at the tuberculosis and respiratory diseases diagnosis center. Int J Chem Biochem Sci 2023;24:206–14.

[17] Carranza C, Carreto-Binaghi LE, Guzmán-Beltrán S, Muñoz-Torrico M, Torres M, González Y, et al. Sex-Dependent Differential Expression of Lipidic Mediators Associated with Inflammation Resolution in Patients with Pulmonary Tuberculosis. Biomolecules 2022;12. https://doi.org/10.3390/BIOM12040490.

[18] Singh S, Zahiruddin QS, Lakhanpal S, Ballal S, Kumar S, Bhat M, et al. Wealth-based inequalities in tuberculosis prevalence among households having children and young adults in India: insights from Indian demographic and health surveys (2015–2021). BMC Infect Dis 2025;25:21. https://doi.org/10.1186/s12879-024-10301-7.

[19] Iqbal T, Rizvi Z, Bokhary H, Javeed J, Ashfaq A, Zahra M, et al. Awareness About pulmonary tuberculosis among patients visiting a tertiary care hospital in Pakistan. Rawal Med J 2018;43:581–581.

[20] Rahmawati M. FAKTOR-FAKTOR YANG MEMPENGARUHI PEMBERIAN ASI EKSKLUSIF PADA IBU MENYUSUI DI KELURAHAN PEDALANGAN KECAMATAN BANYUMANIK KOTA SEMARANG Meiyana 2010;1:1–18.

[21] Andrade C. Understanding relative risk, odds ratio, and related terms: As simple as it can get. J Clin Psychiatry 2015;76:e857–61. https://doi.org/10.4088/JCP.15f10150.

[22] Olarewaju SO, Akande RO, Abu C, Adeyemo C. Factors influencing tuberculosis preventive practices among people living with HIV/AIDS enrolled in secondary health facilities in Lagos, Nigeria. Afr Health Sci 2023;23:97–108. https://doi.org/10.4314/AHS.V23I2.11.

[23] Miandad M, Nawaz-Ul-Huda S, Burke F, Hamza S, Azam M. Educational status and awareness among tuberculosis patients of Karachi. J Pak Med Assoc 2016;66:265–9.

[24] Idris NA, Zakaria R, Muhamad R, Husain NRN, Ishak A, Wan Mohammad WMZ. The Effectiveness of Tuberculosis Education Programme in Kelantan, Malaysia on Knowledge, Attitude, Practice and Stigma Towards Tuberculosis among Adolescents. Malays J Med Sci 2020;27:102–14. https://doi.org/10.21315/MJMS2020.27.6.10.

[25] Clin Pract Res J, Ture Z, Demir B, Elönü F, Kalın Ünüvar G, Öztürk A. Latent Tuberculosis Infection in Healthcare Workers: A Cross-Sectional Study from a Tertiary Hospital in Central Anatolia. J Clin Pr Res 2024;46:484–90. https://doi.org/10.14744/cpr.2024.23434.

[26] Lee S, Lee W, Kang SK. Tuberculosis infection status and risk factors among health workers: an updated systematic review. Ann Occup Environ Med 2021;33:e17. https://doi.org/10.35371/AOEM.2021.33.E17.

[27] Babalik A, Bakirci N, Oruc K, Kiziltaş Ş, Çetintaş G, Altunbey S, et al. Occupation and tuberculosis: A descriptive study in Turkish patients with tuberculosis. Tuberk Toraks 2012;60:32–40. https://doi.org/10.5578/tt.3030.

[28] Ting H, Bozzola M, Ravetti C. Tuberculosis and labour market participation: Evidence from South Africa. South African J Econ 2024;92:444–74. https://doi.org/10.1111/SAJE.12385.

[29] Uchimura K, Ngamvithayapong-Yanai J, Kawatsu L, Ohkado A, Yoshiyama T, Ito K, et al. Permanent employment or public assistance may increase tuberculosis survival among working-age patients in Japan. Int J Tuberc Lung Dis 2015;19:312–8. https://doi.org/10.5588/IJTLD.14.0104.

[30] Ilic M, Kuruc V, Pavlovic S, Kopitovic I, Kasikovic-Lecic S, Zvezdin B, et al. Tuberculosis in a developing country — how much patients know about disease. Cent Eur J Med 2011 72 2011;7:249–57. https://doi.org/10.2478/S11536-011-0124-Z.

[31] World Health Organization. WHO | WHO End TB Strategy. 2015.

[32] Abdulsalam Othman S, Taher Omar KM, MTaher Omar K, Taha Abdulazeez S. Faktor Yang Berhubungan Dengan Kepatuhan Minum Obat Penderita TB Parursud dr.Lapalaloi Maros. Wind Public Heal J 2023;72:161–77.

[33] Amalia NWR. Hubungan Antara Karakteristik Sosiodemografi dengan Tingkat Kepatuhan Minum Obat Pasien Hipertensi di RSUD H. Badaruddin Kasim Tanjung. Repos UNB 2024.

[34] WHO. Consolidated Guidelines on Tuberculosis, Diagnosis. 2020.

[35] Duko B, Gebeyehu A, Ayano G. Prevalence and correlates of depression and anxiety among patients with tuberculosis at WolaitaSodo University Hospital and Sodo Health Center, WolaitaSodo, South Ethiopia, Cross sectional study. BMC Psychiatry 2015;15. https://doi.org/10.1186/S12888-015-0598-3.

[36] Theron G, Peter J, Zijenah L, Chanda D, Mangu C, Clowes P, et al. Psychological distress and its relationship with non-adherence to TB treatment: a multicentre study. BMC Infect Dis 2015;15. https://doi.org/10.1186/S12879-015-0964-2.

[37] Agbeko CK, Mallah MA, He B, Liu Q, Song H, Wang J. Mental Health Status and Its Impact on TB Treatment and Its Outcomes: A Scoping Literature Review. Front Public Heal 2022;10. https://doi.org/10.3389/FPUBH.2022.855515/PDF.

[38] Anye LC, Agbortabot Bissong ME, Njundah AL, Siewe Fodjo JN. Depression, anxiety and medication adherence among tuberculosis patients attending treatment centres in Fako Division, Cameroon: cross-sectional study. BJPsych Open 2023;9. https://doi.org/10.1192/BJO.2023.42.

[39] Dixit K, Rai B, Aryal TP, de Siqueira-Filha NT, Dhital R, Sah MK, et al. Stigma, depression, and quality of life among people with pulmonary tuberculosis diagnosed through active and passive case finding in Nepal: a prospective cohort study. BMC Glob Public Heal 2024 21 2024;2:20-. https://doi.org/10.1186/S44263-024-00049-2.

[40] Awad K, Jaam M, Awaisu A, Stewart D, Rathore HA, Abdul Hadi M. Impact of pharmaceutical care interventions in improving clinical outcomes among patients with pulmonary tuberculosis: a systematic review. J Pharm Policy Pract 2024;17. https://doi.org/10.1080/20523211.2024.2305770.

[41] Yadav RK, Kaphle HP, Yadav DK, Marahatta SB, Shah NP, Baral S, et al. Health related quality of life and associated factors with medication adherence among tuberculosis patients in selected districts of Gandaki Province of Nepal. J Clin Tuberc Other Mycobact Dis 2021;23. https://doi.org/10.1016/j.jctube.2021.100235.

[42] Octavia DR, Hermansyah A, Nita Y, Priyandani Y, Pristianty L, Ming LC, et al. The adherence–quality of life paradox in tuberculosis care after COVID-19: a cross-sectional study in Indonesia. Discov Public Heal 2025;22:704. https://doi.org/10.1186/S12982-025-01111-6.

[43] Qiu L, Tong Y, Lu Z, Gong Y, Yin X. Depressive Symptoms Mediate the Associations of Stigma with Medication Adherence and Quality of Life in Tuberculosis Patients in China. Am J Trop Med Hyg 2019;100:31–6. https://doi.org/10.4269/AJTMH.18-0324.

[44] Lahai M, Conteh SM, Vandy A, Abiri OT, Thompson B, Bawoh M, et al. Assessment of health-related quality of life and adherence to antituberculosis therapy among patients in three tertiary hospitals in Sierra Leone: a cross-sectional study. Discov Public Heal 2025 221 2025;22:448-. https://doi.org/10.1186/S12982-025-00817-X.

[45] Kastien-Hilka T, Rosenkranz B, Schwenkglenks M, Bennett BM, Sinanovic E. Association between health-related quality of life and medication adherence in pulmonary tuberculosis in South Africa. Front Pharmacol 2017;8. https://doi.org/10.3389/FPHAR.2017.00919.

[46] Lutfian L, Azizah A, Wardika IJ, Wildana F, Maulana S, Wartakusumah R. The role of family support in medication adherence and quality of life among tuberculosis patients: A scoping review. Japan J Nurs Sci 2025;22. https://doi.org/10.1111/JJNS.12629.

[47] Adriani RB, Sulistyowati D, Murti B, Hapsari HI. Impact of Tuberculosis Prevention Therapy Policies on Quality of Life Among Patients in Surakarta, Indonesia. Afr J Nurs Midwifery 2025;27:12 pages-12 pages. https://doi.org/10.25159/2520-5293/18630.

[48] Giovenco D, Shah NS, Ansorge K, Operario D, Gandhi NR. New drugs are not enough: addressing social determinants as a critical component of drug-resistant TB care. IJTLD Open 2025;2:183–6. https://doi.org/10.5588/IJTLDOPEN.25.0075.

[49] Gu C, Liu B, Wang H, Ma Y, Guo L. The chain-mediating roles of social support and depression in the relationship between tuberculosis knowledge and self-management: a cross-sectional study based on the ABC-X model. Front Public Heal 2025;13:1640626. https://doi.org/10.3389/FPUBH.2025.1640626/BIBTEX.

[50] Pandia P, Syafiuddin T, Bachtiar A, Rochadi K. The Relationship between Concordance Behaviour with Treatment Compliance and Quality Of Life of Patients with Pulmonary Tuberculosis in Medan. Open Access Maced J Med Sci 2019;7:1536–9. https://doi.org/10.3889/OAMJMS.2019.321.

[51] Ariyanti F, Nurmansyah MI, Wardani RK, Zilhadia, Kilic B. The impact of health system responsiveness on tuberculosis treatment adherence in public primary healthcare facilities in Indonesia. Clin Epidemiol Glob Heal 2025;34. https://doi.org/10.1016/J.CEGH.2025.102107.

[52] Fernandes A, Laohaprapanon S, Nam TT, Sequeira EMDC, Le CN. Adherence to Pulmonary Tuberculosis Medication and Associated Factors Among Adults: A Cross-Sectional Study in the Metinaro and Becora Sub-Districts, Dili, Timor-Leste. Int J Environ Res Public Health 2024;21. https://doi.org/10.3390/IJERPH21121662.

[53] Qomariyah FN, Piyabanditkul L. Association between Health Literacy and Medication Adherence among Pulmonary Tuberculosis Patients Using Four Domains of the Integrated Health Literacy Model in Jember Regency, Indonesia. J Heal Lit 2023;8:9–21. https://doi.org/10.22038/JHL.2023.71529.1408.

[54] Bamidele J, Abiodun O, Sodeinde K, Daniel O. Quality of life among tuberculosis patients on treatment in Southwest Nigeria. Indian J Tuberc 2024;71:S184–90. https://doi.org/https://doi.org/10.1016/j.ijtb.2023.04.009.