Psychological and Psychosocial Determinants of Tuberculosis Medication Adherence: A Systematic Review of Resilience, Stigma, and Coping
Rohmani, Tintin Sukartini, MakhfudliObjectives
To systematically synthesize global evidence on psychological and psychosocial determinants influencing medication adherence among patients with tuberculosis (TB) and drug‐resistant TB (DR‐TB), with a focus on resilience, stigma, coping mechanisms, and related psychosocial factors.
Methods
This systematic review was conducted following PRISMA 2020 guidelines. A comprehensive literature search was conducted in PubMed, Scopus, Web of Science, and CINAHL from January 2015 to March 2026. Eligible studies included quantitative, qualitative, and mixed‐methods designs examining psychological and psychosocial determinants of TB or DR‐TB medication adherence. Study selection, data extraction, and methodological quality assessment were conducted independently by two reviewers using the Joanna Briggs Institute (JBI) critical appraisal tools. A narrative thematic synthesis was applied due to heterogeneity in study designs and outcome measures.
Results
Twelve studies conducted in Nigeria, Cameroon, China, Romania, Ethiopia, South Africa, Eritrea, Somaliland, Indonesia, and India were included. Study designs comprised cross‐sectional, qualitative, cohort, and randomized controlled trials. Reported psychological and psychosocial determinants included resilience, coping strategies, depression, anxiety, stigma, self‐stigma, and social support. Resilience and social support were frequently reported as facilitators of medication adherence, while psychological distress and stigma‐related factors were commonly reported as barriers to adherence. Most included studies were of high methodological quality, with three studies rated as moderate quality. These findings suggest an interconnected psychosocial system in which risk and protective factors dynamically interact to influence adherence behavior.
Conclusions
Psychological and psychosocial determinants are important factors associated with medication adherence among patients with TB and DR‐TB. These findings highlight the importance of integrating psychosocial and mental health support into TB care programs to improve adherence and treatment outcomes. The findings further indicate that adherence behavior emerges from the interaction between psychological risk and protective mechanisms rather than isolated determinants. Future studies should focus on longitudinal and intervention‐based designs to strengthen causal evidence.