Ritualized embodiment and moral self-cultivation: a Confucian model of psychological transformation.

Despite the development of new classes of TB drugs and Gene X-pert for diagnosis of TB, the tuberculosis epidemic remains a public health threat world-wide. The World Health Organization (WHO) estimated that in 2013 there were 9.0 million new cases of TB disease and 1.5 million deaths from the disease,. An estimated 10.6 million people (95% CI: 9.9–11 million) fell ill with TB in 2021, an increase of 4.5% from 10.1 million (95% CI: 9.5–10.7 million) in 2020; similarly the number of drug resistant TB (450,000) and deaths (1.5 million) from TB appear to be on the rise. In Uganda 90,000 people fell ill with TB and 37.5 TB deaths per 100,000 population in 2021. A major challenge to global tuberculosis control is non-adherence to treatment which is associated with treatment failure, acquired drug resistance, and death,,. In Uganda, it is estimated that up to 11% of tuberculosis patients do not comply with the treatment course at two months; and in Kampala city, where a quarter of the notified cases in Uganda reside, non-compliance is around 20%. Studies have found that promoting compliance through a patient centered approach is more effective than defaulter tracing. Non-adherence to treatment arises from multiple factors affecting the quality of tuberculosis care, but there are few studies that have evaluated beyond patient factors into the organization and processes of tuberculosis service delivery. In addition, the current tuberculosis program and clinical research have focused only on hard outcome variables such as mortality and microbiologic cure, and have not considered patient preferences such as satisfaction with care, which may be an important determinant in treatment adherence. Further, patients' beliefs and attitudes may influence how patients take drugs. Patient satisfaction is a legitimate measure of health care quality, and is defined as a health care recipient's reaction to salient aspects of his or her experience of a service. Satisfaction is assumed to consist of a cognitive evaluation and an emotional reaction to the structure, process and outcome of services. Greater satisfaction may be associated with superior adherence, improved attendance at return visits, and better outcomes, making patient satisfaction, a key determinant, for adherence to treatment,.