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Qualitative assessment of the impact of socioeconomic and cultural barriers on uptake and utilisation of tuberculosis diagnostic and treatment tools in East Africa: a cross-sectional study

OBJECTIVES: Early diagnosis and timely treatment are key elements of a successful healthcare system. We assessed the role of socioeconomic and cultural norms in accelerating or decelerating uptake and utilisation of health technologies into policy and practice. SETTING: Secondary and tertiary level...

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Autores principales: Msoka, Elizabeth F, Orina, Fred, Sanga, Erica Samson, Miheso, Barbara, Mwanyonga, Simeon, Meme, Helen, Kiula, Kiula, Liyoyo, Alphonce, Mwebaza, Ivan, Aturinde, Augustus, Joloba, Moses, Mmbaga, Blandina, Amukoye, Evans, Ntinginya, Nyanda Elias, Gillespie, Stephen H, Sabiiti, Wilber
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8276309/
https://www.ncbi.nlm.nih.gov/pubmed/34253677
http://dx.doi.org/10.1136/bmjopen-2021-050911
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author Msoka, Elizabeth F
Orina, Fred
Sanga, Erica Samson
Miheso, Barbara
Mwanyonga, Simeon
Meme, Helen
Kiula, Kiula
Liyoyo, Alphonce
Mwebaza, Ivan
Aturinde, Augustus
Joloba, Moses
Mmbaga, Blandina
Amukoye, Evans
Ntinginya, Nyanda Elias
Gillespie, Stephen H
Sabiiti, Wilber
author_facet Msoka, Elizabeth F
Orina, Fred
Sanga, Erica Samson
Miheso, Barbara
Mwanyonga, Simeon
Meme, Helen
Kiula, Kiula
Liyoyo, Alphonce
Mwebaza, Ivan
Aturinde, Augustus
Joloba, Moses
Mmbaga, Blandina
Amukoye, Evans
Ntinginya, Nyanda Elias
Gillespie, Stephen H
Sabiiti, Wilber
author_sort Msoka, Elizabeth F
collection PubMed
description OBJECTIVES: Early diagnosis and timely treatment are key elements of a successful healthcare system. We assessed the role of socioeconomic and cultural norms in accelerating or decelerating uptake and utilisation of health technologies into policy and practice. SETTING: Secondary and tertiary level healthcare facilities (HCFs) in three East African countries. Level of HCF was selected based on the WHO recommendation for implantation of tuberculosis (TB) molecular diagnostics. PARTICIPANTS: Using implementation of TB diagnostics as a model, we purposively selected participants (TB patients, carers, survivors, healthcare practitioners, community members, opinion leaders and policy-makers) based on their role as stakeholders. In-depth interviews, key informant interviews and focus group discussions were held to collect the data between 2016 and 2018. The data were transcribed, translated, coded and analysed by thematic-content analysis. RESULTS: A total of 712 individuals participated in the study. Socioeconomic and cultural factors such as poverty, stigma and inadequate knowledge about causes of disease and available remedies, cultural beliefs were associated with low access and utilisation of diagnostic and treatment tools for TB. Poverty made people hesitate to seek formal healthcare resulting in delayed diagnosis and resorting to self-medication and cheap herbal alternatives. Fear of stigma made people hide their sickness and avoid reporting for follow-up treatment visits. Inadequate knowledge and beliefs were fertile ground for aggravated stigma and believing that diseases like TB are caused by spirits and thus cured by spiritual rituals or religious prayers. Cultural norms were also the basis of gender-based imbalance in accessing care, ‘I could not go to hospital without my husband’s permission’, TB survivor. CONCLUSION: Our findings show that socioeconomic and cultural factors are substantial ‘roadblocks’ to accelerating the uptake and utilisation of diagnostic and treatment tools. Resolving these barriers should be given equal attention as is to health system barriers.
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spelling pubmed-82763092021-07-27 Qualitative assessment of the impact of socioeconomic and cultural barriers on uptake and utilisation of tuberculosis diagnostic and treatment tools in East Africa: a cross-sectional study Msoka, Elizabeth F Orina, Fred Sanga, Erica Samson Miheso, Barbara Mwanyonga, Simeon Meme, Helen Kiula, Kiula Liyoyo, Alphonce Mwebaza, Ivan Aturinde, Augustus Joloba, Moses Mmbaga, Blandina Amukoye, Evans Ntinginya, Nyanda Elias Gillespie, Stephen H Sabiiti, Wilber BMJ Open Health Services Research OBJECTIVES: Early diagnosis and timely treatment are key elements of a successful healthcare system. We assessed the role of socioeconomic and cultural norms in accelerating or decelerating uptake and utilisation of health technologies into policy and practice. SETTING: Secondary and tertiary level healthcare facilities (HCFs) in three East African countries. Level of HCF was selected based on the WHO recommendation for implantation of tuberculosis (TB) molecular diagnostics. PARTICIPANTS: Using implementation of TB diagnostics as a model, we purposively selected participants (TB patients, carers, survivors, healthcare practitioners, community members, opinion leaders and policy-makers) based on their role as stakeholders. In-depth interviews, key informant interviews and focus group discussions were held to collect the data between 2016 and 2018. The data were transcribed, translated, coded and analysed by thematic-content analysis. RESULTS: A total of 712 individuals participated in the study. Socioeconomic and cultural factors such as poverty, stigma and inadequate knowledge about causes of disease and available remedies, cultural beliefs were associated with low access and utilisation of diagnostic and treatment tools for TB. Poverty made people hesitate to seek formal healthcare resulting in delayed diagnosis and resorting to self-medication and cheap herbal alternatives. Fear of stigma made people hide their sickness and avoid reporting for follow-up treatment visits. Inadequate knowledge and beliefs were fertile ground for aggravated stigma and believing that diseases like TB are caused by spirits and thus cured by spiritual rituals or religious prayers. Cultural norms were also the basis of gender-based imbalance in accessing care, ‘I could not go to hospital without my husband’s permission’, TB survivor. CONCLUSION: Our findings show that socioeconomic and cultural factors are substantial ‘roadblocks’ to accelerating the uptake and utilisation of diagnostic and treatment tools. Resolving these barriers should be given equal attention as is to health system barriers. BMJ Publishing Group 2021-07-11 /pmc/articles/PMC8276309/ /pubmed/34253677 http://dx.doi.org/10.1136/bmjopen-2021-050911 Text en © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published by BMJ. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.
spellingShingle Health Services Research
Msoka, Elizabeth F
Orina, Fred
Sanga, Erica Samson
Miheso, Barbara
Mwanyonga, Simeon
Meme, Helen
Kiula, Kiula
Liyoyo, Alphonce
Mwebaza, Ivan
Aturinde, Augustus
Joloba, Moses
Mmbaga, Blandina
Amukoye, Evans
Ntinginya, Nyanda Elias
Gillespie, Stephen H
Sabiiti, Wilber
Qualitative assessment of the impact of socioeconomic and cultural barriers on uptake and utilisation of tuberculosis diagnostic and treatment tools in East Africa: a cross-sectional study
title Qualitative assessment of the impact of socioeconomic and cultural barriers on uptake and utilisation of tuberculosis diagnostic and treatment tools in East Africa: a cross-sectional study
title_full Qualitative assessment of the impact of socioeconomic and cultural barriers on uptake and utilisation of tuberculosis diagnostic and treatment tools in East Africa: a cross-sectional study
title_fullStr Qualitative assessment of the impact of socioeconomic and cultural barriers on uptake and utilisation of tuberculosis diagnostic and treatment tools in East Africa: a cross-sectional study
title_full_unstemmed Qualitative assessment of the impact of socioeconomic and cultural barriers on uptake and utilisation of tuberculosis diagnostic and treatment tools in East Africa: a cross-sectional study
title_short Qualitative assessment of the impact of socioeconomic and cultural barriers on uptake and utilisation of tuberculosis diagnostic and treatment tools in East Africa: a cross-sectional study
title_sort qualitative assessment of the impact of socioeconomic and cultural barriers on uptake and utilisation of tuberculosis diagnostic and treatment tools in east africa: a cross-sectional study
topic Health Services Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8276309/
https://www.ncbi.nlm.nih.gov/pubmed/34253677
http://dx.doi.org/10.1136/bmjopen-2021-050911
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