貝里斯的克里歐派翠懷特健康中心病人之結核病行為信念的相關因素分析

Background: About one third of the world’s population has latent tuberculosis (TB). TB still remains a public health concern in many developing countries including Belize. Globally, cases of TB have continued to rise due to the HIV pandemic, an increase in demographic stress, and also poorly managed control programs. The aim of this study is to describe the scope of the TB behavioral beliefs associated factors among patients at the Cleopatra White Health Center in Belize, using a framework comprising of the Health Belief Model and the Theory of Reasoned Action Model.

Methods: This is a cross-sectional survey using a structured questionnaire. This study recruited 204 participants. A Tuberculosis Interview Instrument (TII) was used to collect the patients’ socio-demographic, clinical factors and variables from July 2015 to September 2015. The Scientific and Ethics Committee for the Ministry of Health in Belize granted permission for the study to be conducted. A critical level of p=0.05 was used to assess the significance. A multivariate logistic regression model was used to analyze the intention to be screened for tuberculosis and intention to return to have the test read.

Results: Out of 204 participants, almost seventy percent aged from 18 to 30 years, with over half of the subjects being females and single. Seventy-six patients were previously screened for TB, in which 53 were negative, 14 positive and 9 did not state their results. Education level was associated with perceived susceptibility (P=0.02) and general normative belief (P=0.01). Participants with higher academic levels tended to have more perceived susceptibility and general normative belief. In addition, participants with age from 31-82 had less negative intention to be screened Purpose of visit was associated with perceived susceptibility (P<0.001), perceived severity (P<0.001), perceived benefits (P<0.001), perceived barriers (P=0.04), general attitude about TB (P<0.001), and general subjective norm (P<0.001). Furthermore, participants outside of the Belize District and those without sufficient knowledge of TB had more negative intention to be screened for TB and more negative intention to return to have their test read after two days. The multivariate logistic regression analysis showed that knowledge about TB was associated with intention to be screened for TB (P=0.03) and general attitude about TB (P=0.04). Intention was positively correlated with susceptibility (r=. 373, P < 0.01), benefits (r=. 357, P<0.01), attitude (r=. 440, P<0.01) and subjective norm (r=. 184, P<0.01).

Conclusions: In this study, there were five factors in relation to TB behavior beliefs. Results suggested that patients from the Chest Clinic had better behavioral beliefs than those in the general clinic. Education played a vital role in having better behavioral beliefs about TB. Age was a risk factor for intention to be screened for TB since patients aged from 31-82 had less negative intention to be screened, suggesting that the young and most productive age group is at a higher risk of contracting TB. Both Residence and knowledge were also risk factors since patients outside of the Belize District and patients with no knowledge of TB had more negative intention to be screened for TB and intention to return to have their test read after two days. Lastly, cigarette smoking was also a risk factor for intention to return to have your test read after two days. This suggests that smokers would actually have positive intention to be screened for TB, but would not return to have their test read after two days. In conclusion, the findings of this study can guide the Ministry of Health policies in Belize and may contribute to the reduction of TB prevalence in the general population.