Knowledge, Psychological Distress, and Medication Beliefs Among Tuberculosis Patients in Southwest China: A Mediation Analysis

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.