Don't forget the bigger picture The impact of societal issues on a community-based TB programme, Swaziland

摘要

Purpose - The purpose of this paper is to explore the wider societal issues that can impact on thernsuccess of a TB programme.rnDesign/methodology/approach - The paper is a qualitative study of the experiences of peoplerninvolved in a community-based DOTS programme in Lubombo, Swaziland, involving patients, DOTrntreatment supporters, clinic nurses and other key informants.rnFindings - The paper finds that study participants spontaneously raised two main societal issues,rnwhich had major impact on the success of the TB programme: health beliefs and poverty. It is seen thatrnhealth beliefs can have a major impact on treatment-seeking behaviour and outcomes of TB treatment.rnProblems related to poverty were of two main types: insufficient funds to attend for review, and lack ofrnfood whilst on TB treatment.rnOriginality/value - This paper discusses why these issues, although strictly outside the remit of thernhealth services, are important factors to consider when implementing TB programmes. It suggestsrnfurther research that may help break the link between TB and poverty (particularly relating to foodrninsecurity) and recommends considering local health beliefs when dealing with individuals and therncommunity. Neither the impact of health beliefs nor the impact of poverty are new ideas, yet thesernissues tend to be forgotten by quantitative researchers who perhaps understandably focus on issuesrnthat may be perceived as being easier to measure. This paper serves to remind one of their importancernand to illustrate the value of qualitative research in highlighting them and ensuring that issues that arernimportant to participants are not neglected.