Tuberculosis stigma as a social determinant of health: a systematic mapping review of research in low incidence countries

Abstract

Tuberculosis (TB)-related stigma is an important social determinant of health. Research generally highlights how stigma can have a considerable impact on individuals and communities, including delays in seeking health care and adherence to treatment. There is scant research into the assessment of TB-related stigma in low incidence countries. This study aimed to systematically map out the research into stigma. A particular emphasis was placed on the methods employed to measure stigma, the conceptual frameworks used to understand stigma, and whether structural factors were theorized. Twenty-two studies were identified; the majority adopted a qualitative approach and aimed to assess knowledge, attitudes, and beliefs about TB. Few studies included stigma as a substantive topic. Only one study aimed to reduce stigma. A number of studies suggested that TB control measures and representations of migrants in the media reporting of TB were implicated in the production of stigma. The paucity of conceptual models and theories about how the social and structural determinants intersect with stigma was apparent. Future interventions to reduce stigma, and measurements of effectiveness, would benefit from a stronger theoretical underpinning in relation to TB stigma and the intersection between the social and structural determinants of health.

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.…”

“…53 We recognise that TB stigma interacts on complex levels with psychological, social and political factors. 41,43,54 The impact of stigma is therefore not unidirectional and not always negative. For example, stigma can make some patients more adherent 29,55 and some less adherent.…”

The Association Between Perceived Stigma Towards Tuberculosis and the Implementation of Diagnosis Procedure on Tuberculosis Screening Program in Denpasar, Bali, Indonesia

“…It will be very useful to plan proper education and knowledge to reduce the perceived stigma (Somma et al, 2008;Arcêncio et al, 2014).Similar finding is found in several studies regarding TB screening, case finding and consequence of TB stigma. A comprehensive health education to raise awareness and reduce the perceived stigma towards TBis main recommendation in those studies (Kidd et al, 2009;Arcêncio et al, 2014;Cremers et al, 2015;Craig et al, 2017).…”

“…Perceived stigma is a perceived among people regarding social exclusion in population whichrelated to certain diseases. Social exclusion is one of social determinant of health that have major consequent in health inequity (Hatzenbuehler, Phelan and Link, 2013;Craig et al, 2017). Most presumptive TB cases (51.3%) perceived that other people would consider them inferior if they have TB (Abebe et al, 2010).…”

Tuberculosis en niños y adolescentes: estrategias para la intervención de los trabajadores sociales

“…Por ser una enfermedad "contagiosa" y ser considerada "una enfermedad de la pobreza", 12 la estigmatización y marginación de quienes la padecen puede ser una barrera para aceptar el diagnóstico 16 y, mucho más, comunicarlo a sus familiares para que asistan a los centros de salud a realizar los exámenes diagnósticos necesarios. 6 Los niños pequeños, generalmente, no contagian, pero los niños mayores y adolescentes pueden tener una forma de tuberculosis similar a la que presentan los adultos, es decir, también pueden ser enfermos bacilíferos.…”