Relational Dynamics of Treatment Behavior Among Individuals with Tuberculosis in High-Income Countries: A Scoping Review.
Relational Dynamics of Treatment Behavior Among Individuals with Tuberculosis in High-Income Countries: A Scoping Review.
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DOI：
10.2147/ppa.s313633
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发表时间：
2021
影响因子：
2.2
通讯作者：
Kielmann K
中科院分区：
文献类型：
--
作者：
Arakelyan S;Karat AS;Jones ASK;Vidal N;Stagg HR;Darvell M;Horne R;Lipman MCI;Kielmann K
尽管结核病发病率在高收入、低发病率（HILI）国家显著下降，但在管理可能难以坚持抗结核治疗（ATT）的脆弱人群的结核病方面仍然存在挑战。与不依从ATT相关的因素有很好的记录;然而，依从性往往被狭隘地视为一个固定的二元变量，强调个人机构和服药行为，而不是更广泛的治疗要求。此外，通过记录的因素作用于正在接受治疗的经验的机制知之甚少。采用关系的方法，强调嵌入动态的社会，结构和卫生系统的背景下，个人，这范围审查的目的是综合定性证据的经验，ATT和机制，通过社会生态因素影响遵守HILI国家。检索了6个电子数据库，以查找1990年1月至2020年5月期间以英文发表的同行评审文献。通过检索纳入研究的参考文献获得其他研究。采用叙述综合法分析从纳入研究中提取的定性数据。在纳入的28项研究中，大多数（86%）报告了卫生系统因素，其次是个人特征（82%），结构影响（61%），社会因素（57%）和治疗相关因素（50%）。纳入的研究强调了支持ATT行为的关系方法的三点：1）个体服用ATT的动机和能力是动态的，与社会，卫生系统和结构因素交织在一起，而不是分开; 2）个体先前存在的寻求健康的经历影响了他们对治疗的看法和他们承诺长期定期服药的能力; 3）社会、文化和政治环境在不同环境下特定因素如何支持或阻碍ATT依从行为中起着重要的中介作用。基于我们的分析，我们建议以人为本的结核病临床管理应该：1）承认ATT在结核病患者的日常生活中既干扰又管理的方式; 2）理解个人的情况以及他们可以获得的支持和资源可能会在治疗过程中发生变化; 3）对影响个体和集体ATT体验的特定背景的社会和文化规范表现出敏感性。
Although tuberculosis (TB) incidence has significantly declined in high-income, low-incidence (HILI) countries, challenges remain in managing TB in vulnerable populations who may struggle to stay on anti-TB treatment (ATT). Factors associated with non-adherence to ATT are well documented; however, adherence is often narrowly conceived as a fixed binary variable that places emphasis on individual agency and the act of taking medicines, rather than on the demands of being on treatment more broadly. Further, the mechanisms through which documented factors act upon the experience of being on treatment are poorly understood. Adopting a relational approach that emphasizes the embeddedness of individuals within dynamic social, structural, and health systems contexts, this scoping review aims to synthesize qualitative evidence on experiences of being on ATT and mechanisms through which socio-ecological factors influence adherence in HILI countries. Six electronic databases were searched for peer-reviewed literature published in English between January 1990 and May 2020. Additional studies were obtained by searching references of included studies. Narrative synthesis was used to analyze qualitative data extracted from included studies. Of 28 included studies, the majority (86%) reported on health systems factors, followed by personal characteristics (82%), structural influences (61%), social factors (57%), and treatment-related factors (50%). Included studies highlighted three points that underpin a relational approach to ATT behavior: 1) individual motivation and capacity to take ATT is dynamic and intertwined with, rather than separate from, social, health systems, and structural factors; 2) individuals’ pre-existing experiences of health-seeking influence their views on treatment and their ability to commit to long-term regular medicine-taking; and 3) social, cultural, and political contexts play an important role in mediating how specific factors work to support or hinder ATT adherence behavior in different settings. Based on our analysis, we suggest that person-centered clinical management of tuberculosis should 1) acknowledge the ways in which ATT both disrupts and is managed within the everyday lives of individuals with TB; 2) appreciate that individuals' circumstances and the support and resources they can access may change over the course of treatment; and 3) display sensitivity towards context-specific social and cultural norms affecting individual and collective experiences of being on ATT.