In this descriptive study of early identification of risk for noncompliance to tuberculosis treatment or prevention regimens, 523 patients, from four ethnic groups, were rated by nurses trained as participant-observers of several predictive factors. The predictive factors included acceptance of diagnosis. attentiveness, eye contact, the treatment's interference with the patient's lifestyle, fear of side effects, fear of needed medical procedures, and the presence and degree of the patient's social support. An observational measure by the nurse of the patient's Health Locus of Control was also included. The patient was asked to provide a self-rating on the degree of difficulty anticipated in following the treatment regimen. The nurse made a compliance prediction for the patient and the patient was then followed for three months to determine appointment and medication compliance. Appointment compliance was measured by the number of monthly appointments kept.

Medication compliance was measured primarily by patient self report; actual pill counts were used when patients returned medications to clinic. Data were analyzed using several statistical methods. including a test of association as well as discriminant analysis. Nurses' predictions of patient compliance were weakly associated with compliance outcomes. Little fear of medication side effects was the predictive factor most closely associated with medication compliance, while eye contact was most closely associated with appointment compliance. Southeast Asian patients had significantly higher levels of appointment compliance in this study Compliance predictive factors varied between Hispanics and Southeast Asians in regards to appointment compliance; while acceptance of diagnosis and little fear of side effects were both positively associated with medication compliance for Hispanics and Southeast Asians. It was concluded that nurses, using the Planned Observation Guide developed during this study, can assess factors relative to patient compliance outcomes. These factors discriminated between compliers and non-compliers at a rate better than by chance alone. Compliance factors and outcomes differed among the ethnic groups studied. Implications for health education: Elements of both the PRECEDE framework and the Health Belief Model are supported by this study. Although Health Locus of Control was related to compliance outcomes, it was difficult to assess Health Locus of Control by observation alone. Patient education in tuberculosis control programs to address the factors which were most indicative of noncompliance in this study. A suggested observation and teaching guide for accomplishing this type of patient education was included.


School of Health

First Advisor

Ruth M. White

Second Advisor

Joyce Hopp

Third Advisor

Jerry Lee

Fourth Advisor

Thomas J. Prendergast

Degree Name

Doctor of Public Health (DrPH)

Degree Level


Year Degree Awarded


Date (Title Page)




Library of Congress/MESH Subject Headings

Tuberculosis -- therapy; Patient Compliance; Patient Education



Page Count

xii; 140

Digital Format


Digital Publisher

Loma Linda University Libraries

Usage Rights

This title appears here courtesy of the author, who has granted Loma Linda University a limited, non-exclusive right to make this publication available to the public. The author retains all other copyrights.


Loma Linda University Electronic Theses and Dissertations

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Loma Linda University. Del E. Webb Memorial Library. University Archives