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

这一博士论文研究项目将研究与结核病有关的耻辱对妇女决定寻求该病的初步诊断和随后治疗的影响。结核病是一种机会性感染，据估计，全球结核病负担在全球范围内占30%至50%，而且还在上升，特别是在艾滋病毒感染率较高的国家。整个发展中世界的妇女都不成比例地承受着与疾病有关的耻辱的负担，这在不同程度上影响着她们的生活————在她们的家庭中、在她们的社区中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身体、社会和经济福祉产生有害影响。该博士生将与赞比亚卢萨卡的非政府组织ZAMBART项目合作，研究个人和社区一级的干预战略在消除与结核病有关的耻辱方面的作用，以评估其有效性和社会网络在积极改变健康行为方面的作用。定性和定量方法相结合，包括人种学实地研究、统计分析和计算模型，将用于探索结核病相关干预策略和行为改变之间的关系。需要探讨的问题包括：(1)干预策略是否改变了人们对结核病和结核病感染者的看法？(2)群体内的积极行为结果是否存在“引爆点”？(3)社会网络中是否存在可识别的群体，作为积极行为改变的位点，向外波及到他们的社区？由于结核病对社区产生不可磨灭的影响，必须审查不断变化的家庭结构和社会网络在卫生决策方面的作用。此外，确定可能更容易受到结核病相关污名的人群是打击有关该病和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。加强对社会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决策者设计有效的公共卫生计划。该项目的结果将对那些研究卫生地理学、决策机制、卫生行为、政策设计和实施以及社会网络的人有价值。作为博士论文研究进步奖，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.