Lau Lincoln L H, Hung Natalee, Dodd Warren, Lim Krisha, Ferma Jansel D, Cole Donald C
Dalla Lana School of Public Health, University of Toronto, Canada.
International Care Ministries Foundation Inc, Philippines.
SSM Popul Health. 2020 Sep 8;12:100664. doi: 10.1016/j.ssmph.2020.100664. eCollection 2020 Dec.
Social trust is an important driver of health seeking behaviours and plays a particularly important role for diseases that have a high degree of stigma associated with them, such as tuberculosis (TB). Individuals experiencing poverty also face additional social and financial barriers in accessing care for TB. We examined an active case finding (ACF) initiative embedded in a program targeting those living in poverty ( implemented by International Care Ministries (ICM), a Philippine-based non-governmental organization (NGO), and analyzed how different forms of social trust may affect the initial uptake of ACF.
Program monitoring data and a cross-sectional survey conducted at the beginning of included six dimensions of social trust: satisfaction with family life, satisfaction with friendships, and level of trust in relatives, neighbours, pastor or religious leader, and local government officials. Amongst individuals suspected of having TB who received referrals post-screening, multilevel modelling examined the effects of social trust on rural health unit (RHU) attendance.
Among the subset of 3350 individuals who received TB screening in 51 communities, 889 (26.5%) were symptom positive and required referral to the RHU, but only 24.1% of those who received referrals successfully attended the RHU. Multilevel regression analysis showed that for each unit increase on the Likert scale in baseline level of family satisfaction and level of trust in relatives, the odds of attending an RHU was 1.03 times (95% CI: 0.99, 1.07) and 1.06 times greater (95% CI: 1.00, 1.11), respectively, independent of other factors.
These results suggest that social trust in family members could play a valuable role in addressing stigma and rejection, both cited as barriers to higher screening rates. It is recommended that ACF programs that target TB, or other diseases that are stigmatized, prioritize trust-building as an important component of their intervention.
社会信任是寻求医疗行为的重要驱动力，对于诸如结核病（TB）等具有高度污名化的疾病而言，其作用尤为重要。贫困人口在获得结核病治疗方面还面临额外的社会和经济障碍。我们研究了一项嵌入针对贫困人口的项目中的主动病例发现（ACF）倡议（由总部位于菲律宾的非政府组织国际关怀事工（ICM）实施），并分析了不同形式的社会信任如何影响ACF的初始接受度。
项目监测数据以及在年初进行的横断面调查涵盖了社会信任的六个维度：对家庭生活的满意度、对友谊的满意度以及对亲属、邻居、牧师或宗教领袖和地方政府官员的信任程度。在筛查后接受转诊的疑似结核病患者中，多水平模型研究了社会信任对农村卫生单位（RHU）就诊率的影响。
在51个社区接受结核病筛查的3350名个体子集中，889人（26.5%）症状呈阳性，需要转诊至RHU，但在那些接受转诊的人中，只有24.1%的人成功前往RHU就诊。多水平回归分析表明，在李克特量表上，家庭满意度基线水平和对亲属的信任程度每增加一个单位，前往RHU就诊的几率分别增加1.03倍（95%置信区间：0.99，1.07）和1.06倍（95%置信区间：1.00，1.11），与其他因素无关。
这些结果表明，对家庭成员的社会信任在消除污名化和排斥方面可能发挥重要作用，而污名化和排斥均被视为较高筛查率的障碍。建议针对结核病或其他受污名化疾病的ACF项目将建立信任作为干预措施的重要组成部分加以优先考虑。
