Tuberculosis-related stigma and its determinants in Dalian, Northeast China: a cross-sectional study

Abstract

Background The stigma of tuberculosis (TB) poses a significant challenge to TB control because it leads to delayed diagnosis and non-adherence. However, few studies on TB-related stigma have been completed in China. The aim of the current study was to explore the status of TB-related stigma and its associated predictive factors among TB patients in Dalian, Northeast China. Methods An institution-based, cross-sectional survey was conducted among outpatients at Dalian Tuberculosis Hospital in Liaoning Province, Northeast China. Data were collected by using a questionnaire that measured TB-related stigma, treatment status, anxiety, social support, doctor-patient communication and so on. A multiple linear regression model was used to determine the predictors of TB-related stigma. Results A total of 601 eligible participants were recruited. The mean score for TB-related stigma was 9.07, and the median score was 10. The average scores for anxiety, social support and doctor-patient communication were 4.03, 25.41 and 17.17, respectively. Multiple linear regression analysis revealed that patients who were female (β = 1.19, 95% CI: 0.38–2.01, P < 0.05), had self-assessed moderate or severe disease (β = 1.08, 95% CI: 0.12–2.03 and β = 1.36, 95% CI: 0.03–2.70, respectively, P < 0.05), and had anxiety (β = 0.38, 95% CI: 0.30–0.46, P < 0.001) were more likely to have a greater level of TB-related stigma than their counterparts. However, a significantly lower level of TB-related stigma was observed in patients with good social support (β = − 0.25, 95% CI: − 0.33--0.17, P < 0.001) and doctor-patient communication (β = − 0.14, 95% CI: − 0.29--0.00, P < 0.05). Conclusions This study showed that stigma among TB patients was high. Targeted attention should be paid to female patients and patients with moderate or severe disease in TB stigma-related interventions. Moreover, the important role of social support and doctor-patient communication in reducing TB-related stigma should also be emphasized.

The relationship among social support, experienced stigma, psychological distress, and quality of life among tuberculosis patients in China

“…Patients with adequate social support from family, friends and community are likely to have better QOL 20 . Furthermore, social support was also an important predictor of stigma 21 . Patients with poor social support are more likely to be isolated and alienated, with manifestations such as being denied shared utensils and food by family members and losing their jobs, which may lead to stigma 22 , 23 .…”

“…Moreover, studies have reported that TB-associated stigma is associated with psychological stress disorders. These factors can increase the risk of mental health problems, such as psychological distress 21 , 32 , 33 .…”

Knowledge, Attitude, and Practices Toward Tuberculosis Among Hospital Outpatients in Kabul, Afghanistan

“…This is similar to what's reported in other parts of the world. For instance, in a study conducted in China, a high rate of stigma among TB patients was observed, particularly among females ( 11 ). Similarly, in Peru, where TB is a high burdened disease, there is a considerable lack of knowledge among participants on the symptoms; this further emphasizes the need for health literacy and education awareness ( 12 ).…”

Supporting tuberculosis program in active contact tracing: a case study from Pakistan

“…More accurate and credible data from rural areas might provide glimpses of actual prevalence and current burden of disease in the country. Besides estimation of the actual burden of disease, it is imperative to raise awareness about symptoms, its mode of transmission, prevention, diagnosis and treatment, and most importantly, destigmatization of the disease through health education at the grass root level [ 14 , 15 ].…”