Tuberculosis Treatment Adherence as a Relational and Cultural Process: A Qualitative Study From Urban Indonesia

Tuberculosis (TB) treatment adherence remains a major public health challenge, particularly where illness is experienced within family and social contexts. This study examined how TB patients and family members described treatment adherence in an urban Indonesian primary healthcare setting, with attention to relational and cultural dimensions. A qualitative exploratory descriptive study was conducted at across primary health facility in Kupang, East Nusa Tenggara, Indonesia, using individual semi-structured interviews with six TB patients and five family members. Data were analysed using reflexive thematic analysis. Adherence appeared as a temporally unfolding process shaped by emotional adjustment, household obligation, and faith. Six themes were constructed: psychological disruption at diagnosis; fragile illness acceptance and early non-adherence; stigma as a social identity threat; cultural explanatory models; family as behavioural infrastructure; and spirituality as therapeutic reinforcement. Where prior literature has treated family support, stigma, and cultural belief as separate variables, this study shows how these forces interact across the treatment trajectory, reframing TB adherence as a relational process that households actively produce. Programmes engaging families as active participants, addressing stigma at the household level, and communicating within patients' cultural frameworks may better support adherence in collectivist settings.