A mixed methods study on men's and women's tuberculosis care journeys in Lusaka, Zambia-Implications for gender-tailored tuberculosis health promotion and case finding strategies.
Men and women with undiagnosed tuberculosis (TB) in high burden countries may have differential factors influencing their healthcare seeking behaviors and access to TB services, which can result in delayed diagnoses and increase TB-related morbidity and mortality. A convergent, parallel, mixed-metho...
| Main Authors: | , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Public Library of Science (PLoS)
2023-01-01
|
| Series: | PLOS Global Public Health |
| Online Access: | https://doi.org/10.1371/journal.pgph.0001372 |
| _version_ | 1827825671545552896 |
|---|---|
| author | Andrew D Kerkhoff Chanda Mwamba Jake M Pry Mary Kagujje Sarah Nyangu Kondwelani Mateyo Nsala Sanjase Lophina Chilukutu Katerina A Christopoulos Monde Muyoyeta Anjali Sharma |
| author_facet | Andrew D Kerkhoff Chanda Mwamba Jake M Pry Mary Kagujje Sarah Nyangu Kondwelani Mateyo Nsala Sanjase Lophina Chilukutu Katerina A Christopoulos Monde Muyoyeta Anjali Sharma |
| author_sort | Andrew D Kerkhoff |
| collection | DOAJ |
| description | Men and women with undiagnosed tuberculosis (TB) in high burden countries may have differential factors influencing their healthcare seeking behaviors and access to TB services, which can result in delayed diagnoses and increase TB-related morbidity and mortality. A convergent, parallel, mixed-methods study design was used to explore and evaluate TB care engagement among adults (≥18 years) with newly diagnosed, microbiologically-confirmed TB attending three public health facilities in Lusaka, Zambia. Quantitative structured surveys characterized the TB care pathway (time to initial care-seeking, diagnosis, and treatment initiation) and collected information on factors influencing care engagement. Multinomial multivariable logistic regression was used to determine predicted probabilities of TB health-seeking behaviors and determinants of care engagement. Qualitative in-depth interviews (IDIs; n = 20) were conducted and analyzed using a hybrid approach to identify barriers and facilitators to TB care engagement by gender. Overall, 400 TB patients completed a structured survey, of which 275 (68.8%) and 125 (31.3%) were men and women, respectively. Men were more likely to be unmarried (39.3% and 27.2%), have a higher median daily income (50 and 30 Zambian Kwacha [ZMW]), alcohol use disorder (70.9% [AUDIT-C score ≥4] and 31.2% [AUDIT-C score ≥3]), and a history of smoking (63.3% and 8.8%), while women were more likely to be religious (96.8% and 70.8%) and living with HIV (70.4% and 36.0%). After adjusting for potential confounders, the probability of delayed health-seeking ≥4 weeks after symptom onset did not differ significantly by gender (44.0% and 36.2%, p = 0.14). While the top reasons for delayed healthcare-seeking were largely similar by gender, men were more likely to report initially perceiving their symptoms as not being serious (94.8% and 78.7%, p = 0.032), while women were more likely to report not knowing the symptoms of TB before their diagnosis (89.5% and 74.4%; p = 0.007) and having a prior bad healthcare experience (26.4% and 9.9%; p = 0.036). Notably, women had a higher probability of receiving TB diagnosis ≥2 weeks after initial healthcare seeking (56.5% and 41.0%, p = 0.007). While men and women reported similar acceptability of health-information sources, they emphasized different trusted messengers. Also, men had a higher adjusted probability of stating that no one influenced their health-related decision making (37.9% and 28.3%, p = 0.001). In IDIs, men recommended TB testing sites at convenient community locations, while women endorsed an incentivized, peer-based, case-finding approach. Sensitization and TB testing strategies at bars and churches were highlighted as promising approaches to reach men and women, respectively. This mixed-methods study found important differences between men and women with TB in Zambia. These differences suggest the need for gender-tailored TB health promotion, including addressing harmful alcohol use and smoking among men, and sensitizing HCWs to prolonged delays in TB diagnosis among women, and also using gender-specific approaches as part of community-based, active case-finding strategies to improve TB diagnosis in high burden settings. |
| first_indexed | 2024-03-12T02:54:01Z |
| format | Article |
| id | doaj.art-42efb05d0e984fab9d1033674af17c5e |
| institution | Directory Open Access Journal |
| issn | 2767-3375 |
| language | English |
| last_indexed | 2024-03-12T02:54:01Z |
| publishDate | 2023-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLOS Global Public Health |
| spelling | doaj.art-42efb05d0e984fab9d1033674af17c5e2023-09-03T15:25:43ZengPublic Library of Science (PLoS)PLOS Global Public Health2767-33752023-01-0136e000137210.1371/journal.pgph.0001372A mixed methods study on men's and women's tuberculosis care journeys in Lusaka, Zambia-Implications for gender-tailored tuberculosis health promotion and case finding strategies.Andrew D KerkhoffChanda MwambaJake M PryMary KagujjeSarah NyanguKondwelani MateyoNsala SanjaseLophina ChilukutuKaterina A ChristopoulosMonde MuyoyetaAnjali SharmaMen and women with undiagnosed tuberculosis (TB) in high burden countries may have differential factors influencing their healthcare seeking behaviors and access to TB services, which can result in delayed diagnoses and increase TB-related morbidity and mortality. A convergent, parallel, mixed-methods study design was used to explore and evaluate TB care engagement among adults (≥18 years) with newly diagnosed, microbiologically-confirmed TB attending three public health facilities in Lusaka, Zambia. Quantitative structured surveys characterized the TB care pathway (time to initial care-seeking, diagnosis, and treatment initiation) and collected information on factors influencing care engagement. Multinomial multivariable logistic regression was used to determine predicted probabilities of TB health-seeking behaviors and determinants of care engagement. Qualitative in-depth interviews (IDIs; n = 20) were conducted and analyzed using a hybrid approach to identify barriers and facilitators to TB care engagement by gender. Overall, 400 TB patients completed a structured survey, of which 275 (68.8%) and 125 (31.3%) were men and women, respectively. Men were more likely to be unmarried (39.3% and 27.2%), have a higher median daily income (50 and 30 Zambian Kwacha [ZMW]), alcohol use disorder (70.9% [AUDIT-C score ≥4] and 31.2% [AUDIT-C score ≥3]), and a history of smoking (63.3% and 8.8%), while women were more likely to be religious (96.8% and 70.8%) and living with HIV (70.4% and 36.0%). After adjusting for potential confounders, the probability of delayed health-seeking ≥4 weeks after symptom onset did not differ significantly by gender (44.0% and 36.2%, p = 0.14). While the top reasons for delayed healthcare-seeking were largely similar by gender, men were more likely to report initially perceiving their symptoms as not being serious (94.8% and 78.7%, p = 0.032), while women were more likely to report not knowing the symptoms of TB before their diagnosis (89.5% and 74.4%; p = 0.007) and having a prior bad healthcare experience (26.4% and 9.9%; p = 0.036). Notably, women had a higher probability of receiving TB diagnosis ≥2 weeks after initial healthcare seeking (56.5% and 41.0%, p = 0.007). While men and women reported similar acceptability of health-information sources, they emphasized different trusted messengers. Also, men had a higher adjusted probability of stating that no one influenced their health-related decision making (37.9% and 28.3%, p = 0.001). In IDIs, men recommended TB testing sites at convenient community locations, while women endorsed an incentivized, peer-based, case-finding approach. Sensitization and TB testing strategies at bars and churches were highlighted as promising approaches to reach men and women, respectively. This mixed-methods study found important differences between men and women with TB in Zambia. These differences suggest the need for gender-tailored TB health promotion, including addressing harmful alcohol use and smoking among men, and sensitizing HCWs to prolonged delays in TB diagnosis among women, and also using gender-specific approaches as part of community-based, active case-finding strategies to improve TB diagnosis in high burden settings.https://doi.org/10.1371/journal.pgph.0001372 |
| spellingShingle | Andrew D Kerkhoff Chanda Mwamba Jake M Pry Mary Kagujje Sarah Nyangu Kondwelani Mateyo Nsala Sanjase Lophina Chilukutu Katerina A Christopoulos Monde Muyoyeta Anjali Sharma A mixed methods study on men's and women's tuberculosis care journeys in Lusaka, Zambia-Implications for gender-tailored tuberculosis health promotion and case finding strategies. PLOS Global Public Health |
| title | A mixed methods study on men's and women's tuberculosis care journeys in Lusaka, Zambia-Implications for gender-tailored tuberculosis health promotion and case finding strategies. |
| title_full | A mixed methods study on men's and women's tuberculosis care journeys in Lusaka, Zambia-Implications for gender-tailored tuberculosis health promotion and case finding strategies. |
| title_fullStr | A mixed methods study on men's and women's tuberculosis care journeys in Lusaka, Zambia-Implications for gender-tailored tuberculosis health promotion and case finding strategies. |
| title_full_unstemmed | A mixed methods study on men's and women's tuberculosis care journeys in Lusaka, Zambia-Implications for gender-tailored tuberculosis health promotion and case finding strategies. |
| title_short | A mixed methods study on men's and women's tuberculosis care journeys in Lusaka, Zambia-Implications for gender-tailored tuberculosis health promotion and case finding strategies. |
| title_sort | mixed methods study on men s and women s tuberculosis care journeys in lusaka zambia implications for gender tailored tuberculosis health promotion and case finding strategies |
| url | https://doi.org/10.1371/journal.pgph.0001372 |
| work_keys_str_mv | AT andrewdkerkhoff amixedmethodsstudyonmensandwomenstuberculosiscarejourneysinlusakazambiaimplicationsforgendertailoredtuberculosishealthpromotionandcasefindingstrategies AT chandamwamba amixedmethodsstudyonmensandwomenstuberculosiscarejourneysinlusakazambiaimplicationsforgendertailoredtuberculosishealthpromotionandcasefindingstrategies AT jakempry amixedmethodsstudyonmensandwomenstuberculosiscarejourneysinlusakazambiaimplicationsforgendertailoredtuberculosishealthpromotionandcasefindingstrategies AT marykagujje amixedmethodsstudyonmensandwomenstuberculosiscarejourneysinlusakazambiaimplicationsforgendertailoredtuberculosishealthpromotionandcasefindingstrategies AT sarahnyangu amixedmethodsstudyonmensandwomenstuberculosiscarejourneysinlusakazambiaimplicationsforgendertailoredtuberculosishealthpromotionandcasefindingstrategies AT kondwelanimateyo amixedmethodsstudyonmensandwomenstuberculosiscarejourneysinlusakazambiaimplicationsforgendertailoredtuberculosishealthpromotionandcasefindingstrategies AT nsalasanjase amixedmethodsstudyonmensandwomenstuberculosiscarejourneysinlusakazambiaimplicationsforgendertailoredtuberculosishealthpromotionandcasefindingstrategies AT lophinachilukutu amixedmethodsstudyonmensandwomenstuberculosiscarejourneysinlusakazambiaimplicationsforgendertailoredtuberculosishealthpromotionandcasefindingstrategies AT katerinaachristopoulos amixedmethodsstudyonmensandwomenstuberculosiscarejourneysinlusakazambiaimplicationsforgendertailoredtuberculosishealthpromotionandcasefindingstrategies AT mondemuyoyeta amixedmethodsstudyonmensandwomenstuberculosiscarejourneysinlusakazambiaimplicationsforgendertailoredtuberculosishealthpromotionandcasefindingstrategies AT anjalisharma amixedmethodsstudyonmensandwomenstuberculosiscarejourneysinlusakazambiaimplicationsforgendertailoredtuberculosishealthpromotionandcasefindingstrategies AT andrewdkerkhoff mixedmethodsstudyonmensandwomenstuberculosiscarejourneysinlusakazambiaimplicationsforgendertailoredtuberculosishealthpromotionandcasefindingstrategies AT chandamwamba mixedmethodsstudyonmensandwomenstuberculosiscarejourneysinlusakazambiaimplicationsforgendertailoredtuberculosishealthpromotionandcasefindingstrategies AT jakempry mixedmethodsstudyonmensandwomenstuberculosiscarejourneysinlusakazambiaimplicationsforgendertailoredtuberculosishealthpromotionandcasefindingstrategies AT marykagujje mixedmethodsstudyonmensandwomenstuberculosiscarejourneysinlusakazambiaimplicationsforgendertailoredtuberculosishealthpromotionandcasefindingstrategies AT sarahnyangu mixedmethodsstudyonmensandwomenstuberculosiscarejourneysinlusakazambiaimplicationsforgendertailoredtuberculosishealthpromotionandcasefindingstrategies AT kondwelanimateyo mixedmethodsstudyonmensandwomenstuberculosiscarejourneysinlusakazambiaimplicationsforgendertailoredtuberculosishealthpromotionandcasefindingstrategies AT nsalasanjase mixedmethodsstudyonmensandwomenstuberculosiscarejourneysinlusakazambiaimplicationsforgendertailoredtuberculosishealthpromotionandcasefindingstrategies AT lophinachilukutu mixedmethodsstudyonmensandwomenstuberculosiscarejourneysinlusakazambiaimplicationsforgendertailoredtuberculosishealthpromotionandcasefindingstrategies AT katerinaachristopoulos mixedmethodsstudyonmensandwomenstuberculosiscarejourneysinlusakazambiaimplicationsforgendertailoredtuberculosishealthpromotionandcasefindingstrategies AT mondemuyoyeta mixedmethodsstudyonmensandwomenstuberculosiscarejourneysinlusakazambiaimplicationsforgendertailoredtuberculosishealthpromotionandcasefindingstrategies AT anjalisharma mixedmethodsstudyonmensandwomenstuberculosiscarejourneysinlusakazambiaimplicationsforgendertailoredtuberculosishealthpromotionandcasefindingstrategies |