Family adaptation after a recent diagnosis of pulmonary tuberculosis of a household family member in Sisaket Province, Thailand.

Abstract

<italic>Background</italic>. Tuberculosis (TB) morbidity in Thailand is high and rising as interplay among biological, psychological, sociocultural, socioeconomic, and structural factors affect TB-related behaviors, dynamics of TB transmission, and TB control. In Sisaket province, an incidence of 117 cases per 100,000 population was reported, as compared to the national rate of 73 cases per 100,000. <italic>Purposes</italic>. The purposes of this study are to (1) document individual TB patients' and family members' appraisals of adaptations to a recent diagnosis of pulmonary TB in Sisaket province, Thailand; (2) determine factors affecting TB preventive behaviors, treatment adherence by patients, and treatment outcomes; and (3) propose and evaluate a predictive model for TB preventive behaviors and TB patients' treatment adherence and outcomes. <italic>Sample</italic>. A convenience sample of 198 dyads of pulmonary TB patients and family members residing in rural Sisaket Province of Thailand was used. <italic>Methods</italic>. A cross-sectional comparative, correlational design, based on synthesized models of the Transactional Model of Stress and Coping, the Family Adaptation Model, and the McMaster Model of Family Functioning, was used. Data were collected through personal interviews using structured questionnaires. The synthesized models were tested using Structural Equation Modeling. <italic>Results</italic>. The mean age of patients and family member participants was 55.3 and 45.3 years old, respectively. A higher proportion of patients was male, whereas the proportion of females was higher in family member participants. The majority of participants had a primary school level education (6 years in school) or less. TB patients and family members performed a reasonable level of TB Preventive Behaviors. Higher levels of Primary Appraisal, Secondary Appraisal, and Family Functioning increased TB Preventive Behaviors in patients. In family members, TB Preventive Behaviors were decreased by higher levels of Stress but were increased by Social Support. Social Support increased TB Prevention Appraisal and enhanced Family Coping Efforts in patients and family members. TB Prevention Appraisal and Family Functioning predicted patient treatment outcomes. The proposed models explained 50% and 16% of the variance in patients' TB Preventive Behaviors and treatment outcomes, respectively. <italic>Conclusion</italic>. Helping families of TB patients develop plans for coping with difficulties may include requesting assistance from family, friends, and professional health care providers; instilling confidence within one's own family that everyone can contribute; exploring family resource options; and promoting efficacy beliefs regarding TB prevention. The small sample size was a major limitation for model testing.