Measurement of Tuberculosis treatment adherence: A methodological scoping review of observational studies
4 affiliations
- 1EPIUnit ITR, Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal
- 2Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
- 3Faculdade de Psicologia e Ciências da Educação da Universidade do Porto, Porto, Portugal
- 4INSA - Instituto Nacional de Saúde Doutor Ricardo Jorge - INSA Porto, Porto, Portugal
Abstract
Despite extensive conceptual development, the definition and measurement of Tuberculosis (TB) treatment adherence remain inconsistent. This ambiguity obscures what is being assessed and compared across studies. This scoping review examined how adherence is labelled, defined, and operationalised in observational studies of drug-susceptible TB, assessed consistency with contemporary frameworks, and identified methodological gaps. We conducted a scoping review of observational studies on drug-susceptible TB identified from eight databases up to February 2026. Data were extracted on terminology, measurement approaches, and operational definitions. Content analysis was used to map labels and indicators to the constructs they implicitly presuppose. One hundred and three studies were included. Treatment-taking behaviour was mostly assessed through clinician assessment or self-report. Explicit definitions were uncommon, and operational criteria served as de facto definitions. Multidimensional measures were frequently reduced to binary or ordinal outcomes, and most studies relied on cross-sectional designs, reinforcing static representations of a dynamic process. Thus, TB adherence research faces a fundamental problem of construct conflation: the same label is used to describe behaviours that are conceptually distinct, limiting comparability and weakening the interventions’ evidence base. Standardising reporting requirements would strengthen the evidence base for programmes addressing structural and social drivers of adherence.
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BibTeX
@article{ramos2026measurement,
title = {{Measurement of Tuberculosis treatment adherence: A methodological scoping review of observational studies}},
author = {João Pedro Ramos and Catarina Simas and Mariana Vieira and Ana Aguiar and Ana Rute Costa and Marta Pinto and Raquel Duarte},
journal = {PLOS Global Public Health},
year = {2026},
month = oct,
doi = {10.1371/journal.pgph.0007422},
url = {https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0007422},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Measurement of Tuberculosis treatment adherence: A methodological scoping review of observational studies
AU - João Pedro Ramos
AU - Catarina Simas
AU - Mariana Vieira
AU - Ana Aguiar
AU - Ana Rute Costa
AU - Marta Pinto
AU - Raquel Duarte
PY - 2026
DA - 2026/10/07
JO - PLOS Global Public Health
DO - 10.1371/journal.pgph.0007422
UR - https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0007422
AB - Despite extensive conceptual development, the definition and measurement of Tuberculosis (TB) treatment adherence remain inconsistent. This ambiguity obscures what is being assessed and compared across studies. This scoping review examined how adherence is labelled, defined, and operationalised in observational studies of drug-susceptible TB, assessed consistency with contemporary frameworks, and identified methodological gaps. We conducted a scoping review of observational studies on drug-susceptible TB identified from eight databases up to February 2026. Data were extracted on terminology, measurement approaches, and operational definitions. Content analysis was used to map labels and indicators to the constructs they implicitly presuppose. One hundred and three studies were included. Treatment-taking behaviour was mostly assessed through clinician assessment or self-report. Explicit definitions were uncommon, and operational criteria served as de facto definitions. Multidimensional measures were frequently reduced to binary or ordinal outcomes, and most studies relied on cross-sectional designs, reinforcing static representations of a dynamic process. Thus, TB adherence research faces a fundamental problem of construct conflation: the same label is used to describe behaviours that are conceptually distinct, limiting comparability and weakening the interventions’ evidence base. Standardising reporting requirements would strengthen the evidence base for programmes addressing structural and social drivers of adherence.
SN - 2767-3375
ER -