'I lost my faith and stopped taking the medicines' – need for an intervention model based on health belief constructs for improving adherence to tuberculosis treatment

Background: India is reporting the highest number of tuberculosis (TB) cases worldwide. The health belief model has proved beneficial to understand health-related behaviors among patients with TB. We explored the reasons and solutions for non-adherence to the treatment of TB using the constructs of the health belief model. Methods: We conducted in-depth interviews among patients who were reported 'lost to follow up' (LFU) and among the service providers under the national TB program in the Patan district based on the constructs of the health belief model – perceived susceptibility, perceived severity, perceived benefits, and perceived barriers. All the interviews were audio-recorded and transcripts were analyzed using thematic analysis. Results: The analysis resulted in nine major reasons for LFU which were explained under the health belief model constructs. Perceived susceptibility was reflected by lack of support from health workers, losing faith in government, and dependence on alcohol. Negative counseling by quacks explained perceived severity, while improvement in symptoms corroborated with the perceived benefits. Side effects to anti-TB drugs, high pill burden, stigma, and financial constraints were the perceived barriers reported by the patients. Conclusions: The health belief model explains treatment non-adherence behavior among patients with tuberculosis in India. To eliminate TB, program managers in India need to design a comprehensive intervention model to counsel the patients on the benefits of completing treatment, generate awareness to dispel the myths surrounding the disease, and instill confidence through regular visits by health workers. Primary care physicians should try incorporating counselling of patients with TB in their routine care to reduce LFU.