Community perspectives on tuberculosis care in rural South Africa
Community perspectives on tuberculosis care in rural South Africa
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DOI：
10.1111/hsc.12637
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发表时间：
2019-01-01
影响因子：
2.4
通讯作者：
Penn, Claire
中科院分区：
文献类型：
--
作者：
Watermeyer, Jennifer;Penn, Claire
患者不坚持结核病（TB）治疗是一个持续的挑战，特别是自从耐药结核病和艾滋病毒/艾滋病引起的并发症出现以来。一些解决方案可能在于了解患者和社区对结核病护理和治疗依从性障碍的看法。我们使用定性框架，探讨了社区对结核病的看法和信念，以及受结核病影响的南非农村社区中被认为的护理促进因素和障碍。我们对捕捉跨领域主题和参与者的“合并声音”特别感兴趣。 2013 年和 2014 年对 43 名参与者进行了访谈，其中包括家庭护理人员、诊所工作人员、结核病患者以及初级保健诊所及其周围的社区成员。使用主题分析原理对数据进行分析。该研究揭示了背景因素与社区对该疾病的理解之间复杂的相互作用。关于因果关系和寻求治疗路径的文化信仰经常与生物医学观点一起提及。在这个社区中，结核病和艾滋病毒之间存在着密切的联系，而且人们对结核病的了解常常与艾滋病毒相混淆。与艾滋病毒相关的耻辱已延伸至结核病患者。贫困对治疗依从性的影响是一个特别重要的主题。其他主题与诊所在社区中的作用有关。我们的研究强调了该社区的社会经济脆弱性和现有护理系统的脆弱性。研究结果强调需要采取以社区为中心的结核病护理方法，并认识到生活世界的问题。我们讨论这项研究对实践和政策的一些影响。
Patient nonadherence to tuberculosis (TB) treatment is an ongoing challenge, particularly since the advent of drug-resistant TB and complications posed by HIV/AIDS. Some solutions may lie in understanding patient and community perspectives about barriers to TB care and treatment adherence. Using a qualitative framework, we explored community perceptions and beliefs about TB and perceived facilitators and barriers to care in a rural South African community affected by TB. We were particularly interested in capturing cross-cutting themes and the "merged voices" of participants. Interviews were conducted in 2013 and 2014 with 43 participants, including home-based care workers, clinic staff, patients living with TB and community members in and around a primary healthcare clinic. The data were analysed using principles of thematic analysis. The study reveals the complex interplay between contextual factors and community understandings of the disease. Cultural beliefs about causality and treatment-seeking paths were often mentioned in conjunction with biomedical views. There was a strong interface between TB and HIV in this community, and knowledge of TB was often confused with HIV. HIV-related stigma has been extended to those living with TB. The impact of poverty on treatment adherence was a particularly important theme. Other themes related to the role of the clinic in the community. Our study highlights the socioeconomic vulnerability of this community and the fragility of existing care systems. The findings reinforce the need for a community-centred approach to TB care that takes cognisance of lifeworld issues. We discuss some implications of this study for practice and policy.