A qualitative understanding of the health-seeking behaviour of adult in-patients with multi-drug resistant tuberculosis in a public health sector setting.

Abstract

Aim: This study aims to provide a qualitative understanding of the health-seeking behaviour of adult in-patients with multidrug-resistant tuberculosis in a public health sector setting. Methodology: A qualitative methodological approach was used in this study since it allows for an in-depth investigation and understanding of the health-seeking behaviour of MDR-TB patients. The study is seated in the arena of ethnographic inquiry, since ethnography investigates human behaviour as it is understood and experienced within a particular subtext and given reality, as it is created by the people of concern. In this regard, ethnography deals with developing an understanding of shared systems of meaning in societies that share similar social and cultural characteristics and can be applied to the study of any isolated group who have something in common. A total of four (4) 90-minute focus groups discussions were conducted with adult MDR-TB in-patients, comprising two male and two female groups. The data transcripts were analysed thematically in order to identify commonalties and variances among the responses of participants. Comparative analyses were made across the variable gender. Findings: The findings are discussed within the context of relevant empirical literature and theory, including the Health Belief Model, Health Locus of Control Theory and the Theory of Reasoned Action. These findings were constructed temporally in terms of pre-admission, admission and post-admission behaviour. What has emerged in this study is that health-seeking behaviours that are traditionally defined as "poor patient adherence" and " treatment delay" are mediated by a number of variables operating in both institutional and community contexts. At a community level, large-scale community ignorance and lack of knowledge of MDR-TB, social stigma, conflation of TB and MDR-TB and the lack of recognition of symptoms coalesce to produce poor treatment adherence and treatment delays. This situation is exacerbated by cultural practices that result in patients using dual healing systems and multiple remedies. The net result for TB sufferers is the advent of MDR-TB. At an institutional level a hierarchical biomedical bureaucracy conspires to produce a hostile, disempowering and inhumane experience for MDR-TB in-patients, which further compromises adherence behaviour and positive health actions. Recommendations: Within the context of a number of systemic recommendations, a range of practical patient-centered and staff centered interventions are suggested, followed by recommendations for future research and an appraisal of the limitations of this study.