Tuberculosis diagnostics: Why we need more qualitative research

Engel, Nora; Pai, Madhukar

doi:10.1016/j.jegh.2013.04.002

Cited by 22 publications

(19 citation statements)

References 18 publications

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“…The majority of qualitative studies on diagnosis have focused on the health-seeking behavior of patients [5–9], but less so on the practicalities of the diagnostic system and the processes involved in reaching a diagnosis [10,11]. While some studies highlight different notions of risk, body, illness and healing that might influence decisions to seek a diagnosis [12], medical anthropologists such as Farmer [13] have emphasized that structural factors such as poverty and marginality determine care-seeking behavior and adherence to treatment or advice, rather than individual, rational decision making by patients.…”

Section: Introductionmentioning

confidence: 99%

How patients navigate the diagnostic ecosystem in a fragmented health system: a qualitative study from India

Yellapa

Devadasan

Krumeich

et al. 2017

Global Health Action

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Background: Depending on a country’s diagnostic infrastructure, patients and providers play different roles in ensuring that correct and timely diagnosis is made. However, little is known about the work done by patients in accessing diagnostic services and completing the ‘test and treat’ loop. Objective: To address this knowledge gap, we traced the diagnostic journeys of patients with tuberculosis, diabetes, hypertension and typhoid, and examined the work they had to do to arrive at a diagnosis. Methods: This paper draws on a qualitative study, which included 78 semi-structured interviews and 13 focus group discussions with patients, public and private healthcare providers, community health workers, test manufacturers, laboratory technicians, program managers and policymakers. Data were collected between January and June 2013 in rural and urban Karnataka, South India, as part of a larger project on barriers to point-of-care testing. We reconstructed patient diagnostic processes retrospectively and analyzed emerging themes and patterns. Results: The journey to access diagnostic services requires a high level of involvement and immense work from patients and/or their caretakers. This process entails overcoming cost and distance, negotiating social relations, continuously making sense of their illness and diagnosis, producing and transporting samples, dealing with the social consequences of diagnosis, and returning results to the treating provider. The quality and content of interactions with providers were crucial for completion of test and treat loops. If the tasks became overwhelming, patients opted out, delayed being tested, switched providers and/or reverted to self-testing or self-treatment practices. Conclusion: Our study demonstrated how difficult it can be for patients to complete diagnostic journeys and how the health system works as far as diagnostics are concerned. If new point-of-care tests are to be implemented successfully, policymakers, program officers and test developers need to find ways to ease patient navigation through diagnostic services.

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Section: Introductionmentioning

confidence: 99%

How patients navigate the diagnostic ecosystem in a fragmented health system: a qualitative study from India

Yellapa

Devadasan

Krumeich

et al. 2017

Global Health Action

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“…One-third of new cases are estimated to have been left unreported to national TB programmes. Substantial shortcomings in case-detection are not only due to the limitations in available diagnostic strategies and time-consuming laboratory tests (Pai et al, 2012;Engel & Pai, 2013). Barriers to diagnosis and treatment also include geographical challenges, economic difficulties, communication issues (Chemtob et al, 2000), fears of stigma (Nair et al, 1997;Coreil et al, 2010), unregulated private health care practices (Bhargava et al, 2011), non-adherence to treatment (Greene, 2004) and gender biases in health-seeking behaviour (Wang et al, 2008;Atre et al, 2009).…”

Section: Introductionmentioning

confidence: 99%

Social, Historical and Cultural Dimensions of Tuberculosis

et al. 2015

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SummaryTuberculosis (TB) researchers and clinicians, by virtue of the social disease they study, are drawn into an engagement with ways of understanding illness that extend beyond the strictly biomedical model. Primers on social science concepts directly relevant to TB, however, are lacking. The particularities of TB disease mean that certain social science concepts are more relevant than others. Concepts such as structural violence can seem complicated and off-putting. Other concepts, such as gender, can seem so familiar that they are left relatively unexplored. An intimate familiarity with the social dimensions of disease is valuable, particularly for infectious diseases, because the social model is an important complement to the biomedical model. This review article offers an important introduction to a selection of concepts directly relevant to TB from health sociology, medical anthropology and social cognitive theory. The article has pedagogical utility and also serves as a useful refresher for those researchers already engaged in this genre of work. The conceptual tools of health sociology, medical anthropology and social cognitive theory offer insightful ways to examine the social, historical and cultural dimensions of public health. By recognizing cultural experience as a central force shaping human interactions with the world, TB researchers and clinicians develop a more nuanced consideration of how health, illness and medical treatment are understood, interpreted and confronted.

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“…Substantial shortcomings in case-detection are not only due to the limitations in available diagnostic strategies and time-consuming laboratory tests. 15,16 Barriers to diagnosis and treatment also include social, economic, geographical, cultural, and political challenges. Conceptual tools from health sociology and medical anthropology offer useful ways to examine dimensions of public health that may escape the strictly biomedical paradigm.…”

Section: Introductionmentioning

confidence: 99%

Sociocultural dimensions of tuberculosis: an overview of key concepts

Mason

Degeling

Denholm

2015

int j tuberc lung dis

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Abstract:Biomedical innovations are unlikely to provide effective and ethical TB control measures without complementary social science research. However, a strong interest in interdisciplinary work is often undermined by differences in language and concepts specific to each disciplinary approach. Accordingly, biological and social scientists need to learn how to communicate with each other. This article will outline key concepts relating to tuberculosis from medical anthropology and health sociology. Distilling these concepts in an introductory framework is intended to make this material accessible for researchers in laboratory, clinical and fieldwork settings, as well as to encourage more social scientists to engage with tuberculosis research among target groups critical for successful programmatic interventions. For pedagogical purposes, the relevant concepts are grouped into three categories, (1) structures and settings, which includes overarching themes such as syndemics, local biologies, medicalisation, structural violence and surveillance, (2) practices and processes, encompassing gender, stigma, taboo, and victim blaming, and (3) experience and enculturation, which includes illness narratives, biographical disruption and dynamic nominalism. By helping to navigate this literature, we hope to foster more cross-disciplinary conversations between qualitative and quantitative researchers. Tuberculosis, a quintessential social disease, will be controlled more effectively using a multi-stranded research approach. | P a g e Keywords:Gender, Stigma, Surveillance, Syndemics, Social determinants Abstract in FrenchLes innovations du domaine biomédical ont peu de chances de fournir des mesures de lutte contre la tuberculose (TB) à la fois efficaces et éthiques sans recherché complémentaire en sciences sociales. Cependant, le grand intérêt vis-à-vis du travail interdisciplinaire est souvent entravé par des différences de langage et de concepts spécifiques à chaque approche disciplinaire. Les chercheurs en biologie et en sciences sociales doivent apprendre à communiquer entre eux. Cet article va exposer les concepts clés relatifs à la TB en anthropologie médicale et sciences sociales. Distiller ces concepts dans un cadre conceptuel introductif vise à rendre ce matériel accessible aux chercheurs dans les laboratoires, en clinique et sur le terrain, ainsi qu'à encourager davantage de chercheurs en sciences sociales à s'engager dans la recherche sur la TB au sein des groupes cibles cruciaux en termes de succès des interventions. Pour des raisons pédagogiques, les concepts pertinents sont groupés en trois catégories: 1) structures et contextes qui incluent des thèmes transversaux comme les syndémies, la biologie locale, la médicalisation, la violence structurelle et la surveillance; 2) les pratiques et processus incluant le genre, la stigmatisation, les tabous et la culpabilisation des victimes; et 3) l'expérience et l'inculturation qui incluent les récits de maladies, la rupture biographique et le nominalisme dynamique. En...

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Tuberculosis diagnostics: Why we need more qualitative research

Cited by 22 publications

References 18 publications

How patients navigate the diagnostic ecosystem in a fragmented health system: a qualitative study from India

How patients navigate the diagnostic ecosystem in a fragmented health system: a qualitative study from India

Social, Historical and Cultural Dimensions of Tuberculosis

Sociocultural dimensions of tuberculosis: an overview of key concepts

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