{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T12:45:04Z","timestamp":1785415504616,"version":"3.56.0"},"reference-count":54,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T00:00:00Z","timestamp":1778457600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"crossref","award":["72304050"],"award-info":[{"award-number":["72304050"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"crossref"}]},{"award":["72304050"],"award-info":[{"award-number":["72304050"]}],"id":[{"id":"https:\/\/ror.org\/01h0zpd94","id-type":"ROR","asserted-by":"publisher"}]},{"name":"Liangshan State Science and Technology Plan Key Research and Development Project","award":["23ZDYF0112"],"award-info":[{"award-number":["23ZDYF0112"]}]},{"name":"Liangshan State Science and Technology Plan Key Research and Development Project","award":["23ZDYF0025"],"award-info":[{"award-number":["23ZDYF0025"]}]},{"name":"Chengdu University of Traditional Chinese Medicine College","award":["021205076"],"award-info":[{"award-number":["021205076"]}]},{"award":["021205076"],"award-info":[{"award-number":["021205076"]}],"id":[{"id":"https:\/\/ror.org\/00pcrz470","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Healthcare"],"abstract":"<jats:p>Background\/Objectives: Medication beliefs are important determinants of adherence in patients with chronic diseases. Failure to take medication threatens the successful treatment of tuberculosis. This research aimed to determine the associations of tuberculosis knowledge and psychological distress with medication beliefs in patients with tuberculosis from Southwest China. Methods: This study employed a cross-sectional design conducted in Liangshan Prefecture, Southwest China, from March 2024 to January 2025. The HIV-TB co-infection group comprised patients newly diagnosed with HIV-TB co-infection in 2024, while the TB mono-infection group comprised individuals randomly selected from those with tuberculosis mono-infection during the same period within the same region. Trained interviewers collected data through structured telephone questionnaires to assess medication beliefs, psychological distress, TB knowledge, and behavioral characteristics. Path analysis was used to examine the relationships between these variables. Results: Overall medication belief scores were low among participants. Beliefs varied significantly across clinical and sociodemographic factors, being relatively higher in groups such as patients with HIV co-infection, residents of formerly impoverished counties, individuals of Yi ethnicity, and those with primary education or less. Path analysis indicated that psychological distress partially mediated the relationship between TB knowledge and medication beliefs. The indirect effect was 0.014 (95% CI: 0.001, 0.033), accounting for 37.12% of the total effect of knowledge on beliefs, while the direct effect was non-significant. Conclusions: These findings underscore that both TB knowledge and psychological distress critically shape medication beliefs. Intervention strategies should therefore integrate evidence-based health education with targeted psychological support to strengthen treatment adherence and improve outcomes.<\/jats:p>","DOI":"10.3390\/healthcare14101298","type":"journal-article","created":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T10:50:52Z","timestamp":1778496652000},"page":"1298","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Knowledge, Psychological Distress, and Medication Beliefs Among Tuberculosis Patients in Southwest China: A Mediation Analysis"],"prefix":"10.3390","volume":"14","author":[{"given":"Yifei","family":"Zheng","sequence":"first","affiliation":[{"name":"School of Public Health, Chengdu University of Traditional Chinese Medicine, Chengdu 610075, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lingwei","family":"Dou","sequence":"additional","affiliation":[{"name":"Warwick Business School, University of Warwick, Coventry CV4 7AL, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chunnong","family":"Jike","sequence":"additional","affiliation":[{"name":"Liangshan Prefecture Centre for Disease Control and Prevention, Xichang 615000, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rujun","family":"Liao","sequence":"additional","affiliation":[{"name":"Sichuan Provincial Center for Disease Control and Prevention, Chengdu 610041, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gang","family":"Yu","sequence":"additional","affiliation":[{"name":"Liangshan Prefecture Centre for Disease Control and Prevention, Xichang 615000, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ju","family":"Wang","sequence":"additional","affiliation":[{"name":"Liangshan Prefecture Centre for Disease Control and Prevention, Xichang 615000, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruobing","family":"Wang","sequence":"additional","affiliation":[{"name":"Liangshan Prefecture Centre for Disease Control and Prevention, Xichang 615000, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yubing","family":"Wang","sequence":"additional","affiliation":[{"name":"Liangshan Prefecture Centre for Disease Control and Prevention, Xichang 615000, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruili","family":"Bi","sequence":"additional","affiliation":[{"name":"School of Public Administration, China University of Geosciences, Wuhan 430074, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rong","family":"Pei","sequence":"additional","affiliation":[{"name":"School of Public Health, Chengdu University of Traditional Chinese Medicine, Chengdu 610075, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuan","family":"Li","sequence":"additional","affiliation":[{"name":"School of Public Health, Chengdu University of Traditional Chinese Medicine, Chengdu 610075, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,11]]},"reference":[{"key":"ref_1","unstructured":"World Health Organization (2026, March 24). Global Tuberculosis Report 2025. Available online: https:\/\/www.who.int\/teams\/global-programme-on-tuberculosis-and-lung-health\/tb-reports\/global-tuberculosis-report-2025."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e12629","DOI":"10.1111\/jjns.12629","article-title":"The role of family support in medication adherence and quality of life among tuberculosis patients: A scoping review","volume":"22","author":"Lutfian","year":"2025","journal-title":"Jpn. J. Nurs. Sci. JJNS"},{"key":"ref_3","first-page":"1880","article-title":"Influence of health literacy on medication adherence in tuberculosis patients","volume":"39","author":"Kang","year":"2025","journal-title":"Chin. Nurs. Res."},{"key":"ref_4","first-page":"1159","article-title":"Treatment adherence and influencing factors of pulmonary tuberculosis patients in less developed areas of Chongqing","volume":"36","author":"Yu","year":"2021","journal-title":"Dis. Surveill."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1186\/s40249-024-01221-4","article-title":"Discrepancies between self-reported medication in adherence and indirect measurement adherence among patients undergoing antiretroviral therapy: A systematic review","volume":"13","author":"Liao","year":"2024","journal-title":"Infect. Dis. Poverty"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1080\/03007995.2019.1676539","article-title":"Association between non-adherence behaviors, patients\u2019 experience with healthcare and beliefs in medications: A survey of patients with different chronic conditions","volume":"36","year":"2020","journal-title":"Curr. Med. Res. Opin."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"495","DOI":"10.46497\/ArchRheumatol.2020.7732","article-title":"Self-Reported Medication Adherence in Patients with Ankylosing Spondylitis: The Role of Illness Perception and Medication Beliefs","volume":"35","author":"Tolu","year":"2020","journal-title":"Arch. Rheumatol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1590\/S1516-31802013000100018","article-title":"Cross-cultural adaptation of The Beliefs about Medicines Questionnaire into Portuguese","volume":"131","author":"Salgado","year":"2013","journal-title":"Sao Paulo Med. J."},{"key":"ref_9","first-page":"55","article-title":"Analysis on the status quo and influencing factors of medication belief in patients with myasthenia gravis","volume":"53","author":"Cai","year":"2024","journal-title":"Chongqing Med."},{"key":"ref_10","first-page":"234","article-title":"The correlation between medication adherence and beliefs about medication in elderly patients with type 2 diabetes","volume":"49","author":"Liu","year":"2022","journal-title":"Fudan Univ. J. Med. Sci."},{"key":"ref_11","first-page":"22","article-title":"Medication beliefs and adherence in patients with rheumatoid arthritis","volume":"34","author":"Meng","year":"2019","journal-title":"J. Nurs. Sci."},{"key":"ref_12","first-page":"1362","article-title":"Reliability and Validity of Beliefs about Medicines Questionnaire for Highly Active Antiretroviral Therapy","volume":"32","author":"Zhang","year":"2024","journal-title":"Chin. J. Clin. Psychol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"811","DOI":"10.1007\/s11096-024-01727-9","article-title":"The influence of patients\u2019 beliefs about medicines and the relationship with suboptimal medicine use in community-dwelling older adults: A systematic review of quantitative studies","volume":"46","author":"Rafhi","year":"2024","journal-title":"Int. J. Clin. Pharm."},{"key":"ref_14","first-page":"299","article-title":"Cognitive function and willingness toward methadone maintenance treatment among community rehabilitation addicts","volume":"31","author":"Li","year":"2025","journal-title":"Chin. J. AIDS STD"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Li, Y., Ehiri, J., Tang, S., Li, D., Bian, Y., Lin, H., Marshall, C., and Cao, J. (2013). Factors associated with patient, and diagnostic delays in Chinese TB patients: A systematic review and meta-analysis. BMC Med., 11.","DOI":"10.1186\/1741-7015-11-156"},{"key":"ref_16","unstructured":"Glanz, K., Rimer, B.K., and Viswanath, K. (2008). Health Behavior and Health Education: Theory, Research, and Practice, Jossey-Bass\/Wiley. [4th ed.]."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Ruiz-Grosso, P., Cachay, R., De La Flor, A., Schwalb, A., and Ugarte-Gil, C. (2020). Association between tuberculosis and depression on negative outcomes of tuberculosis treatment: A systematic review and meta-analysis. PLoS ONE, 15.","DOI":"10.1371\/journal.pone.0227472"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Dasa, T.T., Roba, A.A., Weldegebreal, F., Mesfin, F., Asfaw, A., Mitiku, H., Teklemariam, Z., Geddugol, B.J., Naganuri, M., and Befikadu, H. (2019). Prevalence and associated factors of depression among tuberculosis patients in Eastern Ethiopia. BMC Psychiatry, 19.","DOI":"10.1186\/s12888-019-2042-6"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Theron, G., Peter, J., Zijenah, L., Chanda, D., Mangu, C., Clowes, P., Rachow, A., Lesosky, M., Hoelscher, M., and Pym, A. (2015). Psychological distress and its relationship with non-adherence to TB treatment: A multicentre study. BMC Infect. Dis., 15.","DOI":"10.1186\/s12879-015-0964-2"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1016\/j.eurpsy.2017.12.027","article-title":"The interplay of etiological knowledge and mental illness stigma on healthcare utilisation in the community: A structural equation model","volume":"51","author":"Schnyder","year":"2018","journal-title":"Eur. Psychiatry"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"2101","DOI":"10.1001\/archinte.160.14.2101","article-title":"Depression Is a Risk Factor for Noncompliance with Medical Treatment: Meta-analysis of the Effects of Anxiety and Depression on Patient Adherence","volume":"160","author":"DiMatteo","year":"2000","journal-title":"Arch. Intern. Med."},{"key":"ref_22","first-page":"1012","article-title":"Health-related quality of life and its influencing factors in patients with Wilson\u2019s diseases based on Tobit model","volume":"52","author":"Dong","year":"2025","journal-title":"Mod. Prev. Med."},{"key":"ref_23","first-page":"20","article-title":"The mediating role of family function and medication belief in relationship between drug literacy and medication adherence in elderly patients with ischemic stroke","volume":"39","author":"Zhang","year":"2024","journal-title":"J. Nurs. Sci."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Liao, R., Hu, L., Liao, Q., Zhu, T., Yang, H., and Zhang, T. (2022). Analysis of death causes of residents in poverty-stricken Areas in 2020: Take Liangshan Yi Autonomous Prefecture in China as an example. BMC Public Health, 22.","DOI":"10.1186\/s12889-022-12504-6"},{"key":"ref_25","first-page":"186","article-title":"Structural Equation Model Testing: Cutoff Criteria for Goodness of Fit Indices and Chi-Square Test","volume":"36","author":"Wen","year":"2004","journal-title":"Acta Psychol. Sin."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"453","DOI":"10.2307\/249524","article-title":"A Confirmatory Factor Analysis of the End-User Computing Satisfaction Instrument","volume":"18","author":"Doll","year":"1994","journal-title":"MIS Q."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1080\/00273171.2022.2163476","article-title":"Dynamic: An R Package for Deriving Dynamic Fit Index Cutoffs for Factor Analysis","volume":"58","author":"Wolf","year":"2023","journal-title":"Multivar. Behav. Res."},{"key":"ref_28","first-page":"443","article-title":"Youth Quality of Life Instrument-Research version (YQOL-R): Psychometric proprieties in a community sample","volume":"88","author":"Salum","year":"2012","journal-title":"J. Pediatr. Rio J."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Chen, L., Huang, Z., Jiang, C., Wu, C., He, S., Zeng, F., Huang, S., and Zhang, F. (2025). Illness perception, coping and psychological distress among patients with metabolic dysfunction-associated fatty liver disease (MAFLD) in China. BMC Public Health, 25.","DOI":"10.1186\/s12889-024-21260-8"},{"key":"ref_30","first-page":"1295","article-title":"Illness perceptions among cancer survivors","volume":"24","author":"Zhang","year":"2016","journal-title":"Support. Care Cancer"},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Kim, G.-G., Yoo, S.-H., Park, M.-S., Park, H.-Y., and Cha, J.-K. (2022). Factors Related to Beliefs about Medication in Ischemic Stroke Patients. J. Clin. Med., 11.","DOI":"10.3390\/jcm11133825"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"133","DOI":"10.14802\/jmd.20147","article-title":"Factors Associated with Medication Beliefs in Patients with Parkinson\u2019s Disease: A Cross-Sectional Study","volume":"14","author":"Kim","year":"2021","journal-title":"J. Mov. Disord."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"703","DOI":"10.1080\/08870446.2010.488265","article-title":"Type D personality predicts poor medication adherence in myocardial infarction patients","volume":"26","author":"Williams","year":"2011","journal-title":"Psychol. Health"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1219","DOI":"10.1007\/s00228-021-03105-0","article-title":"The impact of health literacy on beliefs about medication in a Dutch medication-using population","volume":"77","author":"Visscher","year":"2021","journal-title":"Eur. J. Clin. Pharmacol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1725","DOI":"10.1007\/s00228-024-03738-x","article-title":"Characteristics of isoniazid-induced psychosis: A systematic review of case reports and case series","volume":"80","author":"Appaji","year":"2024","journal-title":"Eur. J. Clin. Pharmacol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1186\/s41983-023-00642-6","article-title":"Cycloserine-induced psychosis in patients with drug-resistant tuberculosis: A systematic review of case reports","volume":"59","year":"2023","journal-title":"Egypt. J. Neurol. Psychiatry Neurosurg."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1023\/A:1026595011371","article-title":"Equivalence of the Mediation, Confounding and Suppression Effect","volume":"1","author":"MacKinnon","year":"2000","journal-title":"Prev. Sci. Off. J. Soc. Prev. Res."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"731","DOI":"10.3724\/SP.J.1042.2014.00731","article-title":"Analyses of Mediating Effects: The Development of Methods and Models","volume":"22","author":"Zhonglin","year":"2014","journal-title":"Adv. Psychol. Sci."},{"key":"ref_39","first-page":"3219","article-title":"Study on antimicrobial resistance of anti-tuberculosis drugs in patients with double infection of HIV\/TB using phage bio-amplification method","volume":"46","author":"He","year":"2017","journal-title":"Chongqing Med."},{"key":"ref_40","unstructured":"(2025, June 22). Notice of the National Bureau of Disease Control and Prevention on Promoting the Experience of Preventing and Controlling Major Infectious Diseases Such as AIDS in Liangshan Prefecture, Sichuan Province. Available online: https:\/\/ncaids.chinacdc.cn\/tzgg_10268\/202405\/t20240517_278338.htm."},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Liao, R., Hu, L., Yu, J., Chen, Y., Chen, M., Yan, J., Li, X., Han, X., Jike, C., and Yu, G. (2024). Association between TB delay and TB treatment outcomes in HIV-TB co-infected patients: A study based on the multilevel propensity score method. BMC Infect. Dis., 24.","DOI":"10.1186\/s12879-024-09328-7"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"508","DOI":"10.1188\/18.ONF.508-526","article-title":"Factors Associated with Medication Beliefs in Patients with Cancer: An Integrative Review","volume":"45","author":"Marshall","year":"2018","journal-title":"Oncol. Nurs. Forum"},{"key":"ref_43","first-page":"1334","article-title":"Situation and determinants of loss to follow-up among HIV\/AIDS patients under antiretroviral treatment in four counties of Liangshan prefecture, 2005\u20132019","volume":"38","author":"Zeng","year":"2022","journal-title":"Chin. J. Public Health"},{"key":"ref_44","first-page":"1818","article-title":"Effect of family care on medication adherence and the mediating role of anxiety in patients who have failed antiretroviral therapy for HIV\/AIDS","volume":"52","author":"Zhang","year":"2025","journal-title":"Mod. Prev. Med."},{"key":"ref_45","first-page":"17","article-title":"Adherence of ART and influence factors among HIV\/AIDS patients in Liangshan prefecture, Sichuan province","volume":"27","author":"Yin","year":"2021","journal-title":"Chin. J. AIDS STD"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"4276047","DOI":"10.1155\/2017\/4276047","article-title":"Diseases Linked to Polypharmacy in Elderly Patients","volume":"2017","author":"Vrettos","year":"2017","journal-title":"Curr. Gerontol. Geriatr. Res."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"555","DOI":"10.1016\/S0022-3999(99)00057-4","article-title":"Patients\u2019 beliefs about prescribed medicines and their role in adherence to treatment in chronic physical illness","volume":"47","author":"Horne","year":"1999","journal-title":"J. Psychosom. Res."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"e20180359","DOI":"10.1590\/1806-3713\/e20180359","article-title":"Smoking and pulmonary tuberculosis treatment failure: A case-control study","volume":"45","author":"Aguilar","year":"2019","journal-title":"J. Bras. Pneumol."},{"key":"ref_49","unstructured":"Chang, S.-H., and Cataldo, J.K. (2025, August 01). A Systematic Review of Global Cultural Variations in Knowledge, Attitudes and Health Responses to Tuberculosis Stigma. Available online: https:\/\/www.ingentaconnect.com\/content\/iuatld\/ijtld\/2014\/00000018\/00000002\/art00008."},{"key":"ref_50","first-page":"322","article-title":"Investigation on tobacco prevalence and tobacco hazards related knowledge among the staffs in departments of chronic disease prevention and control in disease control system of Sichuan Province, 2019","volume":"36","author":"Liu","year":"2020","journal-title":"Chin. J. Health Educ."},{"key":"ref_51","first-page":"641","article-title":"Current Prevalence of tobacco uses among permanent residents aged 15 and above in Changping District of Beijing in 2023","volume":"41","author":"Jia","year":"2025","journal-title":"Chin. J. Health Educ."},{"key":"ref_52","first-page":"3933","article-title":"Chronic non-communicable diseases related to lifestyle and behaviour in part residents, Liangshan","volume":"45","author":"Li","year":"2018","journal-title":"Mod. Prev. Med."},{"key":"ref_53","unstructured":"Zhang, X. (2025). Study on Regional Differences in Healthy Lifestyles Among Chinese Adults and the Evaluation of Community Intervention Effects. [Ph.D. Thesis, Peking Union Medical College]."},{"key":"ref_54","first-page":"764","article-title":"Survey on Smoking and Quitting Behaviors of Residents Aged 18 and Above in Tianjin in 2015","volume":"29","author":"Xue","year":"2021","journal-title":"Chin. J. Prev. Control Chronic Dis."}],"container-title":["Healthcare"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9032\/14\/10\/1298\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T04:22:32Z","timestamp":1778646152000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9032\/14\/10\/1298"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,11]]},"references-count":54,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2026,5]]}},"alternative-id":["healthcare14101298"],"URL":"https:\/\/doi.org\/10.3390\/healthcare14101298","relation":{},"ISSN":["2227-9032"],"issn-type":[{"value":"2227-9032","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,11]]}}}