Navigating the Stigma Terrain: Insights from Individuals with Pulmonary Tuberculosis andHealthcare Delays in India
Abstract
Pulmonary tuberculosis (PTB) is a significant health issue in India, with millions of new cases reported annually. The persistence of PTB is attributed to factors such as poverty, overcrowding, and limited healthcare access. Comprehensive strategies are needed to address this public health
concern, as efforts to control PTB face challenges such as drug resistance and social stigma.
This study investigates the stigmatization experienced by individuals undergoing treatment for pulmonary tuberculosis (PTB) in Aligarh, Uttar Pradesh, India. A sample of 99 participants from
Jawaharlal Nehru Medical College, Aligarh Muslim University (AMU), was selected using stratified and simple random sampling techniques. Statistical analysis comprised of Kruskal-Wallis tests, regression analysis, and goodness-of-fit tests. The regression analysis identified Several
significant stigmatization predictors, including age, family size, rural residence, and access to TB healthcare services. The results revealed gender differences in on-time/delay behaviors, with
females exhibiting higher median ranks, study also identified that, the stigma is relatively higher for the married group, similarly, illiterates experience the most stigma and rural individuals perceive
more stigma compared to urban individuals means patient belongs to the rural areas where the medical facility is at distance feel hesitant to seek the treatment and have fear for the disease as if the community will ostracized by their community after knowing their TB status. This stigma acts
as a barrier to healthcare access, resulted delays in seeking medical assistance, leading to diagnostic delays and worsening health issues. Targeted interventions are crucial in addressing TB
risk factors, especially among the most vulnerable population.
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3. Singh, J., Dinkar, A., & Gupta, P. (2022). Uncommon manifestations in tuberculosis: An expanding clinical spectrum from North India. The International Journal of Mycobacteriology, 11(1), 30–37.
4. Dye, C., Scheele, S., Pathania, V., Raviglione, M. C., & others. (1999). Global burden of tuberculosis: estimated incidence, prevalence, and mortality by country. Jama, 282(7), 677–686.
5. Meentemeyer, R. K., Haas, S. E., & Václavı́k, T. (2012). Landscape epidemiology of emerging infectious diseases in natural and human-altered ecosystems. Annual Review of Phytopathology, 50, 379–402.
6. Nidoi, J., Muttamba, W., Walusimbi, S., Imoko, J. F., Lochoro, P., Ictho, J., Mugenyi, L., Sekibira, R., Turyahabwe, S., Byaruhanga, R., & others. (2021). Impact of socio-economic factors on Tuberculosis treatment outcomes in north-eastern Uganda: a mixed methods study. BMC Public Health, 21, 1–16.
7. Harries, A. D., & Kumar, A. M. (2018). Challenges and progress with diagnosing pulmonary tuberculosis in low-and middle-income countries. Diagnostics, 8(4), 78. https://doi.org/10.3390/diagnostics8040078
8. Getnet, F., Demissie, M., Worku, A., Gobena, T., Tschopp, R., & Seyoum, B. (2020). Longer delays in diagnosis and
9. treatment of pulmonary tuberculosis in pastoralist setting, eastern Ethiopia. Risk Management and Healthcare Policy, 583–594. https://doi.org/10.2147/RMHP.S258186
10. Osman, M. (2021). Tuberculosis-associated mortality in South Africa: longitudinal trends and the impact of health system interventions [Phdthesis]. Stellenbosch: Stellenbosch University.
11. Alema, H. B., Hailemariam, S. A., Misgina, K. H., Weldu, M. G., Gebregergis, Y. S., Mekonen, G. K., & Gebremedhin, K. A. (2019). Health care seeking delay among pulmonary tuberculosis patients in North West zone of Tigrai region, North Ethiopia. BMC Infectious Diseases, 19(1), 1–8.
12. Marrone, J., & Golowka, E. (1999). If work makes people with mental illness sick, what do unemployment, poverty, and social isolation cause? Psychiatric Rehabilitation Journal, 23(2), 187.https://psycnet.apa.org/doi/10.1037/h0095171
13. Mason, P. H., Roy, A., Spillane, J., & Singh, P. (2016). Social, historical, and cultural dimensions of tuberculosis. Journal of Biosocial Science, 48(2), 206–232.https://doi.org/10.1017/S0021932015000115
14. Ciepcielinski, E. (2016). Client perceptions of weight stigma among eating disorder professionals. The University of Texas at San Antonio.
15. Carvalho, E. S. de S., Carneiro, J. M., Gomes, A. S., Freitas, K. S., & Jenerette, C. M. (2021). Why does your pain never get better? Stigma and coping mechanism in people with sickle cell disease. Revista Brasileira de Enfermagem, 74. https://doi.org/10.1590/0034-7167-2020-0831
16. Link, B., & Hatzenbuehler, M. L. (2016). Stigma as an unrecognized determinant of population health: Research and policy implications. Journal of Health Politics, Policy and Law, 41(4), 653–673.https://doi.org/10.1215/03616878-3620869
17. Hand, M., Wren, B., Jennifer, C., Creel, D., & others. (2013). Ethical issues surrounding weight bias and stigma in healthcare. Journal of Health Ethics, 8(2), 4.https://doi.org/10.18785/ojhe.0802.04
18. Pescosolido, B. A., & Martin, J. K. (2015). The stigma complex. Annual Review of Sociology, 41, 87–116.
19. Stangl, A. L., Earnshaw, V. A., Logie, C. H., Van Brakel, W., C. Simbayi, L., Barré, I., & Dovidio, J. F. (2019). The Health Stigma and Discrimination Framework: a global, crosscutting framework to inform research, intervention development, and policy on health-related stigmas. BMC Medicine, 17, 1–13.
20. Bayer, R. (2008). Stigma and the ethics of public health: not can we but should we. Social Science & Medicine, 67(3), 463–472. https://doi.org/10.1016/j.socscimed.2008.03.017
21. Stangl, A. L., Earnshaw, V. A., Logie, C. H., Van Brakel, W., C. Simbayi, L., Barré, I., & Dovidio, J. F. (2019). The Health Stigma and Discrimination Framework: a global, crosscutting framework to inform research, intervention development, and policy on health-related stigmas. BMC Medicine, 17, 1–1
22. Madsen, M., Michaelsen, L., DeCosta, P., & Grabowski, D. (2023). Stigma-Generating Mechanisms in Families Enrolled in a Pediatric Weight Management Program: A Qualitative Study of Health Identities and Healthcare Authenticity. Children, 11(1), 46 https://doi.org/10.3390/children11010046
23. Shabalala, S. B., & Campbell, M. M. (2023). The complexities of trans women’s access to healthcare in South Africa: moving health systems beyond the gender binary towards gender equity. International Journal for Equity in Health, 22(1), 231.
24. Lindsay, S., Fuentes, K., Ragunathan, S., Lamaj, L., & Dyson, J. (2023). Ableism within health care professions: a systematic review of the experiences and impact of discrimination against health care providers with disabilities. Disability and Rehabilitation, 45(17), 2715–2731.https://doi.org/10.1080/09638288.2022.2107086
25. Ruiz, A., Luebke, J., Moore, K., Vann, A. D., Gonzalez Jr, M., Ochoa-Nordstrum, B., Barbon, R., Gondwe, K., & Mkandawire-Valhmu, L. (2023). The impact of the COVID-19 pandemic on help-seeking behaviors of Indigenous and Black women experiencing intimate partner violence in the United States. Journal of Advanced Nursing, 79(7), 2470–2483.https://doi.org/10.1111/jan.15528
26. Powell, I. (2023). The Effects of Stigma Against HIV and Tuberculosis on Patient Mental Health and Healthcare-Seeking Behavior in Dharamshala.
27. Modak, A., Ronghe, V., Gomase, K. P., Mahakalkar, M. G., Taksande, V., & Dukare, K. P. (2023). A Comprehensive Review of Motherhood and Mental Health: Postpartum Mood Disorders in Focus. Cureus, 15(9).
28. Ramos, J. P., Vieira, M., Pimentel, C., Argel, M., Barbosa, P., & Duarte, R. (2023). Building bridges: Multidisciplinary teams in tuberculosis prevention and care.
29. Bohren, M. A., Corona, M. V., Odiase, O. J., Wilson, A. N., Sudhinaraset, M., Diamond-Smith, N., Berryman, J., Tunçalp, Ö., & Afulani, P. A. (2022). Strategies to reduce stigma and discrimination in sexual and reproductive healthcare settings: a mixed-methods systematic review. PLOS Global Public Health, 2(6), e0000582. https://doi.org/10.1371/journal.pgph.0000582
30. Bayer, R. (2008). Stigma and the ethics of public health: not can we but should we. Social Science & Medicine, 67(3), 463–472. https://doi.org/10.1016/j.socscimed.2008.03.017
31. Day, V. E. (2012). Storytelling: The threads of the nursing tapestry [Phdthesis]. Capella University.
32. Shen, N., Sequeira, L., Silver, M. P., Carter-Langford, A., Strauss, J., & Wiljer, D. (2019). Patient privacy perspectives on health information exchange in a mental health context: qualitative study. JMIR Mental Health, 6(11), e13306. https://doi.org/10.2196/13306
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Authors
[1]
“Navigating the Stigma Terrain: Insights from Individuals with Pulmonary Tuberculosis andHealthcare Delays in India”, Soc. sci. humanities j., vol. 8, no. 06, pp. 3861–3876, Jun. 2024, doi: 10.18535/sshj.v8i06.1139.
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