India is grappling with the problem of controlling tuberculosis nearly for the past 50 years. The problem of nonadherence to treatment regimen has also worsened the situation of multidrug resistant tuberculosis (MDR-TB) in India. This article explores the factors behind nonadherence among erstwhile TB defaulters in a rural district in India. In-depth interviews with seven chronic defaulters and with healthcare professionals were conducted at a government-run Chest Clinic. In addition to in-depth interviews with defaulters and healthcare professionals, medical records and government orders related to TB control were examined extensively. Participants were also observed to understand their interaction with healthcare professionals and fellow patients, especially during drug delivery time. Qualitative content analysis is the most appropriate method to analyze the transcribed text and archival records. Qualitative content analysis brought out five major themes responsible for their past nonadherence behavior, namely, (a) Awareness about tuberculosis and treatment, (b) Symptom recognition and self-medication, (c) Family support, (d) Accessibility, and (e) Stigma. Findings are documented according to the major themes and documenting direct quotes from participants and with healthcare professionals wherever appropriate. This case study also provided context-specific recommendations to the healthcare professionals as regards the nonadherence behavior among TB patients. It is hoped these focused recommendations, albeit known to the healthcare professionals, would be extremely useful in making modifications to the existing program to tackle the nonadherence behavior.


Tuberculosis Control, Nonadherence Behavior, Rural India, Qualitative Content Analysis

Author Bio(s)

Karthick Swaminathan is a doctoral research scholar in the Department of Management Studies at Pondicherry University Karaikal Campus, India. Correspondence regarding this article can be addressed directly to: karthick.pu@gmail.com.

Dr. Lalitha Ramakrishnan is Professor in the Department of Management Studies, at Pondicherry University, Karaikal Campus, India.

Dr. CSG Krishnamacharyalu is a Former Professor and Head of Management Studies at Sri Venkateswara University, Tirupati, India.


Karthick would like to thank TB Medical officer and other healthcare professionals for their detailed interviews and allowing me to interview patients in the TB ward. Karthick would also like to thank all the respondents for their interviews and cooperation.

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This work is licensed under a Creative Commons Attribution-Noncommercial-Share Alike 4.0 International License.





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