The adherence–quality of life paradox in tuberculosis care after COVID-19: a cross-sectional study in Indonesia

Abstract

Introduction: Tuberculosis (TB) remains one of Indonesia’s most pressing public health challenges, particularly in the post-COVID-19 era. Medication adherence is widely considered critical to TB treatment success and is often linked to improved quality of life (QoL). However, limited research has explored this relationship in Indonesia. Aim: This study aimed to assess the correlation between medication adherence and QoL and identify factors influencing these outcomes among TB patients. Method: A cross-sectional study was conducted between June and July 2023 at a large public hospital in Surabaya, East Java. Using purposive sampling, 188 adult TB patients were recruited. Medication adherence was measured using the Medication Adherence Report Scale (MARS-5), while QoL was assessed using the St. George’s Respiratory Questionnaire (SGRQ). Descriptive statistics and Pearson correlation analysis were performed. Results: The majority of patients (80.85%) demonstrated high medication adherence, with a mean MARS-5 score of 24.26 (SD ± 2.9). However, QoL was moderate to poor, with a mean SGRQ score of 46.54 (SD ± 17.44), and the activity domain was most adversely affected. No significant correlation was found between medication adherence and QoL (r = 0.006, p = 0.935). Among patient characteristics, only gender was significantly associated with adherence (p = 0.019). Conclusion: This study highlights a critical disconnect between medication adherence and QoL among TB patients in Indonesia. While adherence remains high, it does not guarantee improved well-being. These findings highlight the importance of integrating QoL assessments and psychosocial support into TB care strategies to achieve more comprehensive, patient-centered outcomes.