Doctoral Dissertation Research: The Impact of Social Stigma and Associated Behaviors on Women Seeking Treatment for Tuberculosis Infection in Lusaka, Zambia

本博士论文研究项目将探讨结核病相关的耻辱对妇女寻求初步诊断和随后治疗的决定的影响。 结核病（TB）是一种机会性感染，全球负担估计为30%至50%，并且正在上升，特别是在艾滋病毒流行率高的国家。 整个发展中世界的妇女不成比例地承受着与疾病有关的污名化的负担，这在不同层面上影响着她们的生活-在她们的家庭、在她们的社区以及作为国家话语的一部分。 因此，妇女接受治疗的可能性较小，这加快了疾病的传播速度，并对世界各地社区的物质、社会和经济福祉产生有害影响。 博士生将与赞比亚卢萨卡的非政府组织ZAMBART项目合作，研究个人和社区层面的干预战略在对抗结核病相关污名方面的作用，以评估其有效性和社交网络在积极健康行为改变中的作用。将采用定性和定量相结合的方法，包括民族志实地研究，统计分析和计算模型，以探讨结核病相关的干预策略和行为改变之间的关系。 需要探讨的问题包括：（1）人们对结核病和结核病感染者的看法是否因干预战略而改变？ (2)在群体中，积极的行为结果是否存在“临界点”？ (3)在社交网络中是否有可识别的群体，作为积极行为改变的场所，并向外涟漪到他们的社区？由于结核病在社区中的不可磨灭的影响，重要的是要审查不断变化的家庭结构和社交网络在为卫生决策提供信息方面的作用。 此外，确定哪些人群可能更容易受到结核病相关污名的影响，是消除有关结核病和受感染者的错误信息的第一步。 该项目将提供有关疾病的社会和行为决定因素如何影响其控制的新信息和见解。 加强对社交网络及其在信息传播和行为改变中的作用的理解将有助于研究人员和政策制定者设计有效的公共卫生计划。 该项目的结果将对那些研究健康地理学、决策机制、健康行为、政策设计和实施以及社交网络的人具有价值。 作为博士论文研究改进奖，该项目将提供支持，使有前途的学生建立一个独立的研究生涯。

This doctoral dissertation research project will examine the impact of tuberculosis-related stigma on women's decisions to seek an initial diagnosis and subsequent treatment for the disease. The global burden of tuberculosis (TB), an opportunistic infection, is estimated to be from 30 to 50 percent worldwide and is on the rise, particularly in countries that also have high HIV prevalence. Women throughout the developing world have disproportionately borne the burden of disease-related stigma, and it affects their lives at different scales -- within their families, in their communities and as part of national discourses. As a result, women are less likely to receive treatment for the disease, which hastens the rate of disease transmission and has a deleterious impact on the physical, social, and economic well-being of communities worldwide. The doctoral student will collaborate with ZAMBART Project, a non-governmental organization in Lusaka, Zambia, to examine the role of individual- and community-level intervention strategies that counter TB-related stigma in order to evaluate their effectiveness and the role of social networks in positive health behavior change. A combination of qualitative and quantitative approaches, including ethnographic field research, statistical analysis, and computational models, will be used to explore the relationships among TB-related intervention strategies and behavior change. Questions to be pursued include the following: (1) Do people change their beliefs about TB and TB-infected persons as a result of intervention strategies? (2) Are there "tipping points" in positive behavior outcomes within groups? (3) Are there identifiable groups within social networks that serve as loci for positive behavior change to ripple outward into their communities?Because of the indelible impact of TB in communities, it is important to examine the role of changing family structure and social networks in informing health decision making. In addition, identifying groups of people may be more susceptible to TB-related stigma is the first step in countering misinformation about the disease and infected persons. This project will provide new information and insights regarding how the social and behavioral determinants of disease influence its control. Enhanced understanding of social networks and their role in the diffusion of information and behavior change will assist researchers and policy makers in designing effective public health programs. Results from this project will be of value for those who study the geography of health, mechanisms of decision making, health behavior, policy design and implementation, and social networks. As a Doctoral Dissertation Research Improvement award, this project will provide support to enable a promising student to establish an independent research career.