||Rubel AJ & Garro LC
||Social and cultural factors in the successful control
||PUBLIC HEALTH REP 1992, 107, 626-634.
Early case identification and adherence to treatment
regimens are two remaining barriers to successful TB control. In
many nations, however, fewer than half of those with active disease
receive a diagnosis and fewer than half of those beginning treatment,
complete it. These twin problems derive from complex factors. People's
confusion as to the implications of the TB symptoms, cost of transportation
to clinic services, the social stigma that attaches to TB, the high
cost of medication, organizational problems in providing adequate
follow-up services and patients' perception of clinic facilities
as inhospitable all contribute to the complexity. Socio-cultural
factors such as the cultural understanding that people with symptoms
apply to their disease, staff reluctance to adapt their work environments
to patients' daily activities and the socio-political organisation
of health delivery services have been emphasised. The importance
of studies carried out on three specific subtopics: a) Perception
and interpretation of chest symptoms, b) Influence of social stigma
on help-seeking and adherence to therapy and, c) Adherence to treatment
recommendations are discussed in detail.
A knowledge of the health culture of their patients
must become a critical tool for health care providers if TB programmes
are to be successful. Several anthropological procedures such as
adopting focus group sessions are recommended to help uncover the
health culture of TB patients. Thus, a comprehensive analysis of
the health culture of groups at high risk for TB, as it interacts
with the availability of effective chemotherapy will provide the
needed groundwork to eliminate remaining barriers to successful,
enduring TB control.
|KEYWORDS: SOCIO-CULTURAL; SOCIAL STIGMA; USA.
Waiting room at District TB Clinic in Netherlands