Health-related quality of life and associated factors among adult tuberculosis patients in Kembata Zone, Southern Ethiopia: a mixed-methods cross-sectional study

Abstract

Tuberculosis (TB) remains a major global public health challenge, significantly impacting morbidity and mortality. Assessing the patient-reported Health-Related Quality of Life (HRQoL) is crucial for understanding the comprehensive burden of TB. This study aimed to evaluate HRQoL and its associated factors among adult TB patients in the Kembata Zone, Southern Ethiopia. A concurrent triangulation mixed-methods study was conducted from December 1 to 30, 2023. A multi-stage sampling technique was used to select 597 participants from health facilities across the zone. Quantitative data were collected via interviews using the WHOQOL-BREF instrument, while qualitative data were gathered through In-depth interview questions for Key informants and focus group discussions. Quantitative data were analyzed using multivariable logistic regression to identify factors associated with HRQoL, and qualitative data were thematically analyzed to support and contextualize the findings. Based on dichotomization using the sample mean, 54.9% (95% CI: 51.1–59.1) of participants had an above-average overall HRQoL score. In adjusted analysis, several characteristics were associated with higher odds of below-average HRQoL: married status (AOR = 4.2; 95% CI: 2.4–7.4) and widowed status (AOR = 14.0; 95% CI: 2.3–85.8) compared with being single; secondary education (vs. diploma and above) (AOR = 8.2; 95% CI: 3.6–19.0); extrapulmonary TB (vs. pulmonary TB) (AOR = 13.5; 95% CI: 7.4–24.7); MDR-TB (vs. non-MDR) (AOR = 25.4; 95% CI: 7.3–88.3); and being in the intensive (Phase I) treatment phase (vs. Phase II) (AOR = 10.1; 95% CI: 5.4–19.2). Qualitative findings highlighted profound social stigma, physical debilitation, and healthcare access challenges as key themes affecting well-being. HRQoL among TB patients in the study setting is suboptimal, influenced by marital status, education, TB type, drug resistance, and treatment phase. TB programs should integrate targeted psychosocial support, patient education, and stigma-reduction interventions, with particular attention to married patients, those with EPTB or MDR-TB, and individuals with lower educational attainment. These findings advocate for more holistic, patient-centered care models within national TB control strategies.