Influence on mental health
College students with PTB described various emotions related to their illness, such as anxiety before diagnosed with PTB, badly fear when diagnosed with PTB, anxiety in the beginning of treatment, excessive worry immediately before the first recheck, worry, expectancy and boredom during the whole treatment phase.
Fear about the nature of illness
The majority of the participants reported that their initial reaction to diagnosis of tuberculosis was quite fearfull. They said that they knew little about PTB before they were diagnosed. In their minds, PTB is a very serious disease that would badly harm them. Some of them considered PTB as a disease that could not be cured, and some even feared that they would die from PTB.
'At the news that I was diagnosed with PTB, I was badly fearful. When I was a child, I often heard that if one suffered from it...he would die.' (Male, 20 years old, continuation phase, outpatient)
Two participants reported that although they were not scared, it was hard for them to accept it when diagnosis of PTB was disclosed to them. 'How could I be suffered from PTB? It is absolutely unexpected for me.' (Female, 18 years old, intensive phase, inpatient)
Some participants reported not only a great fear of the harms caused by PTB, but also the fear of infecting their classmates considering the infectious characteristic of PTB. One participant described his psychological process when his classmates were screened as intimate contactors.
'It is an infectious disease. I was worry about the transmission. Whether my classmates and roommates would be infected by me? Oh, I was fearful, badly fearful when thought of it.' (Male, 22 years old, continuation phase, outpatient)
The types of isolation intervention in TB hospitals indicated the patients that PTB was seriously infectious and it would greatly threaten their health, which deepened their feelings of fear.
'I noticed that many people here wear big surgical masks and it seemed strange. I felt badly afraid at first.' (Male, 21 years old, intensive phase, inpatient)
Anxiety about the illness
Most of the patients reported they felt anxious and upset before they were diagnosed. They repeatedly received symptomatic treatment, but could not be cured. They began to confuse the status of them, and they were upset and anxious.
'I suddenly caught a cold and went to see a doctor. However, I caught colds at least three times even after careful medication. Oh, why is it so difficult for me to recover from catching a cold?' (Male, 22 years old, intensive phase, outpatient)
'I had a fever. I told myself that I just caught a cold and everything would be fine. However, it could not be cured for a long time. I began to feel upset--worse and worse.' (Male, 21 years old, intensive phase, inpatient)
At the first week of receiving treatment, some of the patients still could not accept the fact that they suffered from PTB. Although some of the patients accepted it, they were troubled by the possible problems would caused by PTB, such as high expenditure and time-consuming treatment, and they could not fulfil themselves into receiving treatment.
'I had no symptoms. At first, I thought if not suffering from PTB, I could be seriously infected during hospitalization by other PTB patients. What should I do? Those thoughts crammed my mind, and then I had no taste even for the delicious food. I could not sleep well.' (Male, 22 years old, intensive phase, inpatient)
'During the first week of hospitalization, I went to see other doctors to make sure that it really would take me at least 6 months to cure the disease. I went to bed early, but I could not sleep deeply and was easy to be woken up.' (Male, 21 years old, continuation phase, outpatient)
Excessive worry about first recheck
All the participants who had received treatment more than one month reported they were tense and fearful when they will get a check-up after one-month treatment. They were eager to know whether the treatment for the past month was effective or not, but they were badly afraid of the bad news. The two thoughts were mixed and crashed in their minds.
'I really expected to get a check again. However, when the day came, I was worried. If there was any problem, I would have to stay here for a longer time. I was extremely worried. This feeling lasted till I was checked again.' (Male, 21 years old, intensive phase, inpatient)
'It was time to be checked again. I was panic, it cannot be expressed in words. I was worry about the results, whether it is effective or not?' (Male, 22 years old, intensive phase, outpatient)
Expect an early full recovery
Some patients reported that what they concerned most was the effect of the treatment. Inpatients expected that they could be healed and discharged from the hospital as soon as possible.
'The doctor said that the treatment was effective. I could leave here in 10 days. Once I am cured thoroughly, I will not be worried.' (Male, 22 years old, intensive phase, inpatient)
'I just hope I could be cured thoroughly and get a full recovery, and then I can set my minds at rest.' (Male, 24 years old, continuation phase, outpatient)
Worry about future heath and prospects
'PTB will relapse if my study or work is stressful in the future. This problem bothered me a lot.' said a student who would recover soon. (Male, 22 years old, continuation phase, outpatient)
Some patients were worried that the side effects of anti-TB drugs would exist for long terms, especially the outcome of infertility and impaired function of liver and kidney.
'It is said that taking anti-TB drugs might lower fertility, I am rather worried about it.' (Male, 20 years old, continuation phase, outpatient)
The seniors would graduate. Therefore, they were worried about that whether their graduation would be postponed since they were long time absence from class and job seeking opportunity would also be impacted.
'Everything will be difficult for me, if I could not be cured. Maybe I will not be employed...' (Male, 22 years old, intensive phase, inpatient)
Boredom on tedious treatment life
Inpatients only needed an intravenous infusion for a short time and took pills on a regular schedule every day. Outpatients who stayed at home also merely took medicine on time daily and none housework would be assigned to them. There was too much spare time for them, and they became bored.
'I began to take a drip at 8 o'clock and it ended at 10 AM every morning. Then I had nothing to do the whole day...' (Male, 22 years old, intensive phase, inpatient)
'I have nothing to do at home, one month, another month. I am bored to death! After all, I am a young man.' (Male, 21 years old, continuation phase, outpatient)
Influence on daily life
Discontinuation of study
The biggest problem caused by PTB was the disruption of the participants' normal life, especially their studies when receiving treatment. All 17 participants expressed that they strongly desired to study during the treatment. Most of them were unwilling to suspend their schooling duo to the treatment.
'My classmates took action to prepare for postgraduate study or going abroad. But, I am behind in my study and can not do anything. I am so worried.' (Female, 22 years old, intensive phase, inpatient)
'Since I was absence from school for a period, my teachers did not allow me to take exams. And I have to suspend my schooling. It will delay my education by one year!' (Male, 22 years old, intensive phase, inpatient)
'If suspending one's schooling is a rule in my school, I can accept it, rationally. However, once recover from PTB, I prefer to go back to school.' (Male, 22 years old, intensive phase, outpatient)
Being isolated
College students with PTB were unwilling to disclose their disease, because they were afraid of being discriminated. Most of the participants also said that their classmates kept them away intentionally or unintentionally because they did not want to be infected.
'I did not want to see anyone during the treatment. After supper, I sat in the yard for a while and then went to bed. My mother told others I was suffered from pleurisy. We did not tell them the truth, because most of the villagers like to gossip.' (Male, 20 years old, continuation phase, outpatient)
'My closest classmates were estranged from me...but I can understand (smile). If a classmate of mine suffered from PTB, maybe I would also do it.' (Male, 21 years old, intensive phase, inpatient)
'I am self-abased. Others may be disgusted with me. Although I am no longer a source of infection, I still keep away from others.' (Male, 21 years old, intensive phase, inpatient)
Increased financial burden
Most of the participants came from rural areas, and long-term treatment cost them too much. Supplementary drugs used to reduce the side effects of anti-TB drugs were expensive, and improving notorious status also spent money. Therefore, PTB financially burdened some of the patients.
'I come from rural area. Of course, my biggest problem is how to deal with the costs.' (Male, 21 years old, intensive phase, inpatient)
'There are 4 children in my family: 2 are in high school, and 2 are in college. My parents rely on farming and a part-time job to support us. Now, they have to pay so much for the disease.' (Male, 24 years old, continuation phase, outpatient)
Social support
Support from healthcare workers
The majority of the participants reported that they had little chance to communicate with healthcare workers. And they could get very little information on PTB from professionals. Most of the patients were unclear about what convergence management policy and TB free treatment policy were. Only 2 reported that doctors in their college clinics told them the two policies. The majority of the participants also reported that they knew little information about PTB before they were diagnosed with PTB. They got information by communicating with other patients, reading the posters in the hospital or browsing websites. However, they have not been offered any written information bulletin on PTB. Although most of them could state the symptoms, route of transmission, pathogen, duration of treatment after a period of treatment, some still had misconceptions about PTB.
'I knew nothing about PTB before hospitalization. Although, I've been here for half a month, I still know little about it.' (Female, 20 years old, intensive phase, inpatient)
'The way I infected? Oh...maybe I ate something not clean.' (Female, 18 years old, intensive phase, inpatient)
Most of the inpatients reported that the doctors and nurses in the hospital communicated with them occasionally, and they could get little information about their status from doctors and nurses.
'When I asked questions, the doctor only told me to have a good rest. He even did not tell me any information about my illness.' (Male, 24 years old, intensive phase, inpatient)
Support from family members
Most of the participants reported that their family members provided supports for them both physically and emotionally. When they were distressed, their parents or siblings would console them in time. Some inpatients reported that their parents came to look after them for a period from their hometown. Patients who went home to finish continuation phase treatment reported they were well taken care of by their family members.
'My parents always told me not to be worried and they can help me. My elder sister also consoled me frequently.' (Male, 21 years old, intensive phase, inpatient)
Support from friends
Some patients reported that some of their best friends were as friendly as before after they were diagnosed with PTB. Some of their friends even collected information on PTB for them.
'After I was diagnosed with PTB, several best friends of mine searched information about PTB on the internets, and told me what food was good for my health. It made me feel well.' (Male, 20 years old, continuation phase, outpatient).
During the treatment, their friends constantly encouraged them, which empowered them. One patient stated how one of his desk mates supported him.
'She sent me a short message everyday, it was a joke or a phrase which can console me. Just like I was hurt, she cured me.' (Male, 22 years old, intensive phase, outpatient)
However, most of the patients reported that they could not get any support from their friends, and some even kept away from them.
'I have already gone back to school, some of my friends do not treat me as before, and I am feeling uncomfortable, even that I would like to quit school.' (Male, 24 years old, continuation phase, outpatient)