Patient experiences of multi-drug resistant TB treatment in two different settings in the Free State Province
Motseke, Ntombodidi Mary
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The increase in the rate of Multidrug Resistant Tuberculosis (MOR TB) is a serious health threat both globally and locally. In order to address this threat the National Department of health in South Africa introduced a Policy Framework on decentralisation and deinstitutionalisation of management of MOR TB. The introduction of this framework resulted in patients being able to receive MOR TB treatment nearer their homes in two different settings. Patients could receive treatment as either inpatients at a decentralised MDR T~ Unit or as outpatients at a decentralised MOR TB Primary Health Care (PHC) Clinic. - The purpose of this research was to explore and describe the patient's experiences of receiving MOR TB treatment at the two different settings and to compare their experiences. A qualitative, explorative, descriptive and contextual research using an interpretive approach was done. The data for this research was collected by conducting unstructured interviews with six patients from the two settings in March 2016. There was an equal number of participants from each setting. The first group consisted of three patients who were hospitalised at a decentralised MOR TB Unit for treatment and the other group consisted of three patients who received MOR TB treatment at a decentralised MOR TB PHC clinic in the Free State Province. Convenience sampling was used to select the facilities and purposive sampling was used to select the participants. The research was approved by the Free State Department of Health (FSDOH) and the Health Sciences Research Ethics Committee of the University of the Free State (HREC) provided the ethical clearance. Manual coding and Atlas.ti version 7.3 software programme was used for data analysis. The research supervisor was used as a co-coder. Four main themes emerged from the experiences of the participants. The experiences of the participants were either positive or negative. The first theme was about emotional reactions, both groups had negative emotional experiences. They experienced guilt, denial and hurt. The outpatient group further experienced boredom, feeling confined and passive compliance. The second theme was about the treatment environment. Participants' experiences were both negative and positive. The inpatient group had positive experiences regarding the regulated treatment, feedback on clinical progress and unrestricted visitation time. They had negative experience regarding, hospital diet, sporadic presence of the doctor, they experienced lack of emotional care, information, and family su.p port. The outpatients were bothered by isolation, stigma and had an aversion to wearing masks. They had positive experiences regarding treatment environment because there were no long queues, they were able to attend to their family responsibilities, and they valued the support from the doctor and nurses. Some liked the fact that they did not have to travel long distances. The third theme was about family and personal issues. The outpatients group had negative experiences only. They missed their families, could not attend to family and personal responsibilities and the hospital was far for some of the participants. The outpatients group experienced their setting positively, they liked the fact that they were able to attend to family responsibilities. The last theme was support. The inpatients experienced limited family support which was a negative experience. The outpatient had positive experiences of receiving support from staff, other patients and from their families. This research indicated that the group of participants in the outpatient setting experienced less negative experiences than the group of participants in the inpatient setting. Recommendations on this research focused on policy makers, inpatient and outpatient settings and further research. Recommendations for the inpatient and outpatient settings were aligned to Madeleine Leininger's Culture Care: Diversity and Universality (CCDU) theory.