Treating tuberculosis: the essential role of social work

Compliance with preventative measures during the COVID-19 pandemic in the USA and Canada: Results from an online survey

This study explored people's compliance with recommended preventative measures during early stages of the COVID-19 pandemic. An online survey was administered in June 2020 in the USA and Canada (N = 1,405). Regression analysis found that when controlling for other factors, age and political ideology were significant predictors of compliance with preventative measures. A content analysis of narrative answers of compliance/noncompliance found that the majority of individuals intended to comply with preventative measures, with primary reasons as social responsibility, self-protection, and protection of family members. Reasons identified for not complying were viewing preventative practices as unnecessary, getting mixed messages from various sources about effectiveness, distrust in government and inability to comply. This study informs social workers on intervention strategies on micro, mezzo and macro levels of practice.

Patient views on determinants of compliance with tuberculosis treatment in the eastern cape, South Africa: an application of q-methodology

BACKGROUND

: Tuberculosis (TB) constitutes one-quarter of all avoidable deaths in developing countries. In the Eastern Cape, South Africa, TB is a public health problem of epidemic proportion. Poor compliance and frequent interruption to treatment are associated with increased transmission rates, morbidity, and costs to TB control programs. This study explored determinants of (non-)compliance from the patients' perspective.

METHODS

: Semi-structured interviews were conducted with patients (33 treatment compliers and 34 treatment non-compliers) and 14 community health workers from local community clinics and the hospital in the township of Grahamstown, Eastern Cape, South Africa. Q-methodology was used. Patients rank ordered 32 opinion statements describing determinants of treatment compliance from the TB adherence model. By-person factor analysis was used to explore patterns in the rankings of statements by compliers and non-compliers. These patterns were interpreted and described as patient views on determinants of compliance with treatment. Patients and community health workers selected the top five determinants of compliance and non-compliance.

RESULTS

: Compliers believed that completing treatment would cure them of TB. Economic prospects were crucial for compliance. Compliers felt that the support of the government disability grant helped with compliance. Non-compliers believed that stigmatization had the greatest impact on non-compliance, together with the burden of disease, the arrangements involved with receiving treatment, restrictions accompanying treatment, and the association of TB with HIV/AIDS infection.

CONCLUSIONS

: Stigmatization makes TB a 'social disease'. Individual motivation and self-efficacy appear to have a considerable effect on compliance, but, for non-compliers, the general lack of job prospects and being able to provide for themselves or their family also makes TB very much an 'economic disease'.

[Social risk factors for noncompliance with tuberculosis treatment in Pontevedra [Spain]]

OBJECTIVE

To determine the prevalence and characteristics of social risk factors (SRF) for noncompliance with treatment in patients with tuberculosis (TB) in Pontevedra.

METHODS

We performed a descriptive analysis of patients with TB and SRF diagnosed between 1996 and 2002. A patient was considered as having SRF if he or she was socially isolated (alcoholism, intravenous drug use, prison inmate, homelessness or social maladjustment) or was an immigrant. The prevalence, annual trend of SRF and patient outcomes were calculated. The influence of direct observation of treatment administration on the outcome of patients with SRF was also analyzed.

RESULTS

Of 775 patients with TB, 156 (20.1%) had at least one SRF. Eighty-six patients were alcoholic, 41 were intravenous drug users, 24 were immigrants, 11 were homeless, 11 showed social maladjustment and 10 were prison inmates. The presence of SRF among TB patients showed no tendency to increase or decrease during the study period, except for the increasing number of immigrants (chi 2 for lineal tendency = 12.24; p = 0.005). Final outcomes were significantly better in patients without SRF (90.4 vs 70.8% of satisfactory final outcomes; p < 0.001). Direct observation of treatment did not increase satisfactory outcomes in patients with SRF.

CONCLUSIONS

Patients with TB and SRF have a significantly higher proportion of unsatisfactory final outcomes. The presence of SRF is relatively low in our environment. The number of immigrants from countries with a high prevalence of TB shows an incipient tendency to increase. This finding should be taken into account to achieve better control of the disease.

Task orientated nursing in a tuberculosis control programme in South Africa: where does it come from and what keeps it going?

Task oriented nursing is associated with traditional hospital ward organisational practice. This paper describes task orientation in a tuberculosis control programme which forms part of the public health system in Cape Town, South Africa. Task oriented practice is illustrated with clinical data from a focused ethnography on the work of nurses in a tuberculosis control programme. The origins of task orientation are traced to the colonial history of nursing in South Africa. The authors explore both the explicit and more functional reasons for maintaining task orientation, as well as the implicit and mostly unconscious socially structured defences which contribute to the continuation of this form of practice. Unless attention is given to the complexities of this phenomenon, initiatives to change task oriented practice may continue to fail.