Journal Article

Burden of stigma among tuberculosis patients in a pastoralist community in Kenya: A mixed methods study

Mbuthia, Grace Wambura, McGarvey, Stephen T., Nyamogoba, Henry D. N., Chiang, Silvia S.

2020

Overview

Tuberculosis (TB) stigma remains a barrier to early diagnosis and treatment completion. Increased understanding of stigma is necessary for improved interventions to minimise TB stigma and its effects. The purpose of this study is to quantitatively measure TB stigma and to explore qualitatively its manifestation among TB patients in a rural Kenyan community. This hospital based study using explanatory sequential mixed methods approach was conducted in 2016. In the quantitative part of the study, a questionnaire containing socio-demographic characteristics and scales measuring perceived TB stigma and experienced TB stigma, was administered to 208 adult pulmonary TB patients receiving treatment in West Pokot County. Respondents with high stigma were purposively selected to take part in in-depth interviews and focus group discussions. The qualitative data were collected through 15 in-depth interviews and 6 focus group discussions with TB patients. Descriptive and bivariate analysis was done for the quantitative data while the thematic analysis was done for qualitative data. The internal consistency reliability coefficients were satisfactory with Cronbach alphas of 0.87 and 0.86 for the 11-item and 12-item stigma measurement scale. The investigation revealed that TB stigma was high. The key drivers of TB stigma were the association of TB with HIV/AIDS and the fear of TB transmission. TB stigma was exemplified through patients being isolated by others, self-isolation, fear to disclose TB diagnosis, association of TB with human immunodeficiency virus (HIV) and lack of social support. Being a woman was significantly associated with high levels of both experienced stigma (p = 0.007) and perceived stigma (p = 0.005) while age, marital status, occupation and the patient's religion were not. There is a need to implement stigma reduction interventions in order to improve TB program outcomes.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Adolescent / Adult / Aged / Balances (scales) / Biology and Life Sciences / Bivariate analysis / Care and treatment / Clinics / Data collection / Demographic aspects / Diagnosis / Disease transmission / Fear / Female / Focus groups / Health sciences / HIV / Hospitals / Human immunodeficiency virus / Humans / Illnesses / Interviews / Male / Marginalized groups / Medical diagnosis / Medicine and Health Sciences / Methods / Middle Aged / Mixed methods research / Mycobacterium tuberculosis - isolation & purification / Patients / People and Places / Population / Public health / Qualitative analysis / Questionnaires / Reliability analysis / Religion / Research and Analysis Methods / Rural Population - statistics & numerical data / Social aspects / Social interactions / Social Sciences / Social Stigma / Stigma / Stigma (Social psychology) / Surveys and Questionnaires / Tuberculosis / Tuberculosis - diagnosis / Tuberculosis - epidemiology / Tuberculosis - psychology / United States - epidemiology / Viruses / Young Adult