Clinic staff perceptions of tuberculosis treatment delivery in Bali

Feasibility analysis of the value of Q method in the classification and understanding of expert experience

The Q method, combining qualitative and quantitative methods, refers to the qualitative analysis of Q-sorts based on quantitative techniques. It is used to research individual subjective experience, analyzing consensus and divergence to identify and categorize subjects' viewpoints. The sorting process is completely performed by the subjects, independent of study researchers. The Q method in medical research has been applied in many fields, including nursing care, clinical studies, doctor and patient's perceptions, health evaluation and decision making. The authors used the Q method to research Chinese medicine (CM) group decision making, exploring its practical feasibility in this important field. Four primary domains are addressed: (1) integration of expert opinion; (2) expert classification; (3) ascertaining the entire viewpoint orientation of a certain type of expert; and (4) comparison of expert opinion using an additional perspective. The essence of the Q method caters to the CM thinking model and should be introduced into CM and explored more deeply.

Tuberculosis cluster in an immigrant community: case identification issues and a transcultural perspective

OBJECTIVES

In a low incidence area for tuberculosis (TB), a computerized database identified an unusually high proportion of patients coming from one single country between 2004 and 2006. To determine whether they constituted a cluster, whether clustering was due to recent transmission, and to understand what undermined the efficacy of the contact tracing procedure, we conducted a retrospective study of all patients with TB from this country.

METHODS

Mycobacterium tuberculosis isolates of 15 TB cases originating from the same country over a 2(1/2) year period were analysed by restriction fragment length polymorphism (RFLP) and/or Rep-PCR. To identify links between patients, we revisited the social worker's files, cross-matched contacts' databases, and performed internet searches. A cultural evaluation was conducted by an anthropologist and an expert physician, through patient and community key informant interviews and a literature review.

RESULTS

Genotyping confirmed that 11 of 15 patients had identical isolates. Additional data revealed an unsuspected complex network of social links between 9 of these 11 patients. The transcultural evaluation pointed out the major obstacles to efficient contact tracing, such as importance of social stigma related to TB, differences in communication style and health beliefs, and linguistic barriers.

CONCLUSION

The combined finding of identical genotypes and important social links between patients confirmed the suspicion of a TB cluster due to recent transmission. The cultural evaluation helped to explain the difficulties encountered during the contact tracing procedure, and offered strategies to improve its efficacy despite the magnitude of the social stigma attached to TB in this community.