Development of Family and Community Empowerment Guidelines for Medication Adherence and Treatment Success Among Pulmonary Tuberculosis Patients at Phonsawan Hospital, Nakhon Phanom Province

Abstract

Tuberculosis remains a critical public health concern in Thailand, where many patients still experience missed doses and premature treatment discontinuation. Poor medication adherence is a key factor directly affecting treatment success. Empowering families and communities is a viable strategy for strengthening patient participation and reinforcing treatment adherence. This action research aimed to develop and evaluate the effectiveness of family and community empowerment guidelines on medication adherence and treatment success among pulmonary tuberculosis patients. Three outcomes were assessed: medication adherence, treatment success rate, and satisfaction with the guidelines. The study followed the PDCA cycle integrated with Gibson's four-stage empowerment framework. Participants were purposively selected and were comprised of 10 pulmonary tuberculosis patients, 10 family caregivers, 14 healthcare professionals, and 12 community network partners. The research instruments were comprised of the empowerment guidelines, the Tuberculosis Medication Adherence Scale (TBMAS), a satisfaction questionnaire, and a facilitator–barrier assessment form. All instruments were quality-examined by experts: the Thai version of the TBMAS yielded a CVI of 0.97 and a Cronbach's alpha of 0.89, while the satisfaction questionnaire yielded an IOC ≥ 0.50 for all items and a Cronbach's alpha ≥ 0.75. Data were analyzed using descriptive statistics, and medication adherence before and after the intervention was compared using McNemar's exact tests.
After the intervention, medication adherence increased significantly from 20% to 100% (p < .01) and the treatment success rate was 100 percent. Both patients and family members, as well as the healthcare personnel and community partners, reported high levels of satisfaction. Key success factors included the empowerment mechanism, family support, and community networking, while the principal barriers were drug side effects, economic constraints, and social stigma.