Patient acceptance of preventive antibiotic treatment for tuberculosis: a qualitative study

Background

Tuberculosis (TB) preventive treatment is a key component of TB control in low-incidence settings, but uptake remains low.

Objective

To explore factors influencing patient decisions to accept or decline preventive treatment for TB infection.

Design

Qualitative study using semi-structured interviews, analysed with the Theoretical Domains Framework (TDF).

Setting

Routine clinical TB prevention services at two hospitals in London, UK.

Participants

Adults (≥18 years) diagnosed with TB infection and offered preventive treatment.

Methods

Semi-structured interviews were audio-recorded and transcribed verbatim. The TDF was applied to analyse transcripts using a combined inductive thematic analysis and deductive framework approach. Themes were also mapped to the Capability, Opportunity and Motivation model of Behaviour (COM- B) domains.

Results

Twenty-five participants (median age 34 years; 64% male) were included; 56% accepted treatment, 28% declined, and 16% were undecided. Influences on decision-making mapped to 12 of 14 TDF domains. Facilitators of treatment acceptance included perceived risk of TB (beliefs about consequences), desire to protect others’ health (social influences and goals), confidence in treatment adherence (beliefs about capabilities), and routine integration strategies (behavioural regulation). Barriers to treatment acceptance included low perceived individual risk and doubts about necessity or effectiveness (beliefs about consequences), concerns about side effects and treatment burden (environmental context and resources) and anticipated stigma (social influences). Knowledge had a mixed influence, primarily shaping perceived necessity, but did not determine decisions alone. Social, environmental and emotional factors further influenced decisions, with participants balancing anticipated benefits against perceived burden and uncertainty across multiple interacting domains.

Conclusions

Decisions to accept preventive TB treatment are driven by interacting capability, opportunity and motivation factors rather than knowledge alone. Interventions to improve shared decision making should address perceived risk, treatment burden, self-efficacy and social influences.

Registration

Clinicaltrials.gov ( NCT07024836 )

Strengths and limitations of this study

• Use of semi-structured interviews enabled in-depth exploration of patient decision-making about tuberculosis (TB) preventive treatment in routine clinical services.

• The Theoretical Domains Framework (TDF) provided a systematic behavioural framework for coding and interpreting influences on treatment acceptance, with subsequent mapping to Capability, Opportunity and Motivation model of Behaviour (COM-B) domains.

• Recruitment included representative adults offered preventive treatment through different screening pathways and included participants who accepted, declined, or remained undecided about treatment.

• Data were collected from two London hospital sites; future studies could examine generalisability to other settings, including higher TB incidence settings, and those with different models of TB preventive care.