Abstract: Objective To investigate the willingness of patients with pulmonary tuberculosis in Linquan County to adhere to standard treatment and to identify its associated determinants. Methods A cohort of 270 patients initiating standard treatment for pulmonary tuberculosis in the county between August 2021 and August 2025 were enrolled in this study. Data were collected through face-to-face interviews. Willingness to undergo standard treatment was operationalized as medication adherence, which was evaluated at treatment initiation (T0), the one-month follow-up (T1), and at the completion of therapy (T2) using pill counts and WeChat-based check-in records. A comparative analysis was conducted between patients with high and low treatment willingness. Lasso regression was employed to screen for potential predictors of treatment willingness, followed by a multivariate logistic regression analysis to identify the definitive influencing factors. Results Among the 270 participants, 68 (25.19%) exhibited a medication adherence rate of ≤90%, and were thus classified as having a low willingness to accept standard treatment. The Lasso and subsequent multivariate logistic regression analyses revealed that a junior high school education or lower (OR=3.358), unawareness of tuberculosis cure rates (OR=3.264), a monthly family income below 5 000 RMB (OR=4.646), a self-administered supervision model (OR=4.547), and the presence of severe adverse drug reactions (OR=3.945) were significant factors associated with a lower willingness to accept standard treatment (all P<0.05). Conclusion To enhance adherence to standard treatment for pulmonary tuberculosis, health education initiatives should be prioritized for patients with lower educational attainment, those unaware of treatment efficacy, individuals from low-income households, patients on self-administered therapy, and those experiencing severe adverse drug reactions. Strengthening supervision and therapeutic guidance through multifaceted, comprehensive interventions is critical for improving treatment willingness among pulmonary tuberculosis patients at the county level.

Key words: Pulmonary tuberculosis, Treatment willingness, Influencing factors, Medication adherence