Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street, New Orleans, LA 70112, USA.
BMC Health Serv Res. 2013 Jul 31;13:290. doi: 10.1186/1472-6963-13-290.
Tuberculosis (TB) remains a significant public health problem in Peru, causing an estimated 35,000 new cases each year, 6.7% of whom are co-infected with HIV. Social support mechanisms are key in influencing health-seeking behavior, adherence, and overall patient wellbeing in clinical settings. We examine the types of social support received by TB patients and parents of pediatric patients in peri-urban Lima, Peru, to understand its role in patients' psychosocial wellbeing during treatment.
Semi-structured interviews were conducted between August 2004 and May 2005 among 43 individuals: 19 adults with TB, 8 adults with TB/HIV, 13 parents of pediatric TB patients, and 3 parents of pediatric TB/HIV patients.
Patients described the need for psychosocial support to mitigate the difficulty of continually going to the clinic to take medications, tending to other family or professional responsibilities while on treatment, and confronting stigma and social isolation within their community. Family members most often contributed to meeting these psychosocial needs, and were also crucial in providing economic support to patients faced with burdensome medical expenses or who were forced to leave their jobs due to being on treatment. Most healthcare personnel were described as key providers of emotional support and encouragement for patients to successfully adhere to treatment, however there were a select few doctors whose "scare tactics" seemingly discouraged patient adherence. During the treatment process, patients described being more socially withdrawn as a result of feeling fatigued from their medications, however most participants also described forming new mutually supportive friendships among their fellow patients.
Despite the general reluctance of patients to disclose their disease status, patients received a significant amount of psychosocial support from both family members to whom they disclosed, and from positive interactions with healthcare providers. High levels of depression were reported, with many patients voicing need for improved and more frequent psychological interventions. To improve the Peru TB program, participants suggested extending educational opportunities to patients' families and the wider community, increasing the existing amount of nutritional support, and programmatic provision of vocational activities to increase economic opportunities.
结核病（TB）仍然是秘鲁一个重大的公共卫生问题，每年估计有 35000 例新发病例，其中 6.7%合并感染 HIV。社会支持机制是影响临床环境中寻求健康行为、坚持治疗和整体患者健康的关键。我们研究了利马周边地区结核病患者和儿科患者父母所获得的社会支持类型，以了解其在患者治疗期间的心理社会健康中的作用。
2004 年 8 月至 2005 年 5 月期间，我们对 43 人进行了半结构式访谈：19 例成人结核病患者、8 例成人结核病/艾滋病患者、13 例儿科结核病患者的父母、3 例儿科结核病/艾滋病患者的父母。
患者描述了需要社会心理支持来减轻不断去诊所服药的困难，在治疗期间兼顾其他家庭或专业责任，并应对社区内的耻辱和社会孤立。家庭成员最常满足这些社会心理需求，并且在患者面临沉重的医疗费用或因治疗而被迫离职时，也为患者提供经济支持。大多数医疗保健人员被描述为为患者成功坚持治疗提供情感支持和鼓励的关键提供者，但是也有少数医生的“恐吓策略”似乎阻碍了患者的坚持。在治疗过程中，患者因药物引起的疲劳而变得更加社交退缩，但大多数参与者也描述了在他们的病友中形成新的相互支持的友谊。
尽管患者普遍不愿透露自己的疾病状况，但患者从向其透露病情的家庭成员以及与医疗保健提供者的积极互动中获得了大量的社会心理支持。报告了较高水平的抑郁，许多患者表示需要改善和更频繁的心理干预。为了改善秘鲁的结核病项目，参与者建议向患者的家庭和更广泛的社区扩大教育机会，增加现有的营养支持，并提供职业活动方案，以增加经济机会。
