A systematic review of global cultural variations in knowledge, attitudes and health responses to tuberculosis stigma

Abstract

S E T T I N G. 1 TB is a widespread global disease that affects family and social relationships and results in adverse health and economic consequences. 2,3 Individuals with TB and their families can experience prejudice and negative attitudes, such as shame, blame and a sense of judgment. [4][5][6][7][8] Enacted TB stigma refers to exclusion, rejection or devaluation by others against patients and their families based on beliefs of social unacceptability or inferiority. 9 Perceived TB stigma refers to patient and family fears of inferiority stemming from the anticipation of an adverse judgment related to a TB diagnosis. 9 TB stigma can be a barrier to early diagnosis and a deterrent to treatment adherence. 10-13 Multicountry studies comparing TB stigma suggest intra-and intercountry differences. 14-16 However, little is known as to how similarities or differences in the knowledge, attitudes and health responses of individuals or communities infl uence TB stigma. To reduce barriers to diagnosis and treatment pathways, TB stigma needs to be understood within the socio-cultural context. This will allow for control efforts to address stigma at the individual, community and system levels.The aim of this review was to describe the infl uence of stigma on knowledge, attitudes and responses to TB and to identify similarities and differences across countries. METHODSFor this review, the PubMed/Medline, Web of Science, Cochrane, PsycINFO and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases were searched in January 2012. Medical subject heading (MeSH) terms included 1) 'tuberculosis' AND 'tuberculosis/psychology' and 2) 'prejudice' OR 'stereotyping' OR 'social perception' OR 'social stigma' OR 'social isolation' OR 'health knowledge, attitudes, practice.' Inclusion criteria were English language, peer-reviewed, original research using qualitative, quantitative or mixed methods, and study S U M M A R YCultural attitudes toward TB 169 fi ndings related to attitudes, beliefs or responses in relation to TB stigma. Exclusion criteria were intervention studies, review articles, dissertations, commentaries, letters and guidelines. The title and abstract were fi rst reviewed by one author, then both authors screened the remaining articles based on the inclusion criteria.The 'signal and noise' technique, a narrative interpretive method of systematic review and a technique that is intuitive and value-based, was used for study appraisal. 17,18 According to Edwards et al., the 'weight of evidence' in a topic area can be judged by assessing the 'signal' from available research publications and tempering the importance attached by the level of 'noise' (the inverse of methodological quality).' 17 The signal and noise evaluation technique is valid and reliable and can be applied to the 'qualitative overview' segment of systematic reviews. 17 As an alternative to evaluating the quality of studies, a signal score is used to assess the relevance of publications. The process does not eliminate research simply b...

Trained Community Volunteers Improve Tuberculosis Knowledge and Attitudes Among Adults in a Periurban Community in Southwest Nigeria

“…Another important consideration is the varying cultures within the community, which has a mix of ethnic groups, and this has been found to have an influence on stigma. 31 It may have helped if all the ethnic tribes were represented among the CVs chosen by the CDA, but this was not the case; they were all from the Yoruba ethnic group, which is the most populous in the community (Table 1). Future intervention studies aimed at reducing stigma will need to consider such cultural variations.…”

Factors associated with knowledge about tuberculosis and attitudes of relatives of patients with the disease in Ribeirão Preto, São Paulo, Brazil

“…Similar results were found by Ali et al 19 and Bati et al 7 , and that raises the question about the isolation and segregation patients may be subjected to due to the incorrect perception of the families with respect to the mode of transmission. Patient isolation has been described in systematic reviews 23 as a favorable factor to treatment abandonment and discontinuity. It is important to mention that 96% of the cases of tuberculostatic multidrug resistance in Brazil happen due to the acquired form 24 , that is, the nonadhesion to the prescribed therapeutic regimens.…”

Defining the research agenda to measure and reduce tuberculosis stigmas

“…Drivers may also differ by epidemic characteristics (low-or high-burden settings) or by the populations impacted (age, sex and class). 9,14,43,44 Stigma toward people with MDR-TB and extensively drug-resistant TB (XDR-TB) and those with LTBI is likely fostered and sustained by distinct sets of underlying factors. The drivers of MDR-TB stigma may be weighted distinctly from drug-susceptible TB stigma in three ways.…”

“…[10][11][12][13] Link et al, Weiss et al, Pescosolido et al and others have described the extent of how TB stigma can be observed, felt and resisted at different levels of society. 9,[14][15][16][17][18][19] TB stigma can also be present at the level of societal discourse where cultural and social determinants may be more or less important. 14,20 We also learned from research on stigmas other than for TB, with the caveat that not everything will translate readily.…”

“…9,[14][15][16][17][18][19] TB stigma can also be present at the level of societal discourse where cultural and social determinants may be more or less important. 14,20 We also learned from research on stigmas other than for TB, with the caveat that not everything will translate readily. Finally, we built on the work that has outlined the typologies of stigma, 20,21 which are produced in different ways.…”