Teo Alvin Kuo Jing, Tan Rayner Kay Jin, Smyth Caoimhe, Soltan Viorel, Eng Sothearith, Ork Chetra, Sok Ngovlyly, Tuot Sovannary, Hsu Li Yang, Yi Siyan
Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore.
Stop TB Partnership, Geneva, Switzerland.
Open Forum Infect Dis. 2020 Sep 16;7(10):ofaa422. doi: 10.1093/ofid/ofaa422. eCollection 2020 Oct.
Stigma is a significant barrier to healthcare and a factor that drives the global burden of tuberculosis (TB). However, there is a scarcity of information on TB stigma in developing countries. We aimed to characterize, measure, and explore the determinants of TB stigma among people with TB in Cambodia.
We conducted a mixed-methods study between February and August 2019 using a triangulation convergent design-a cross-sectional survey ( = 730) and nested in-depth interviews ( = 31) among people with TB. Quantitative data were analyzed using descriptive statistics and generalized linear regression models. Qualitative transcripts were thematically analyzed.
A total of 56% and 51% of participants experienced self-stigma and perceived stigma by the community, respectively. We found rural dwellers, knowledge of how TB is transmitted, and knowledge that anybody can get TB were associated with higher levels of self-stigma and perceived stigma by the community. Higher scores on knowledge of TB symptoms were inversely associated with both self-stigma and community stigma. Thematic analyses revealed accounts of experienced stigma, acts of intentional distancing and hiding TB diagnosis from others, and feelings of embarrassment and shame.
Tuberculosis stigma was prevalent, suggesting a need for the incorporation of stigma-reduction strategies in the national TB responses. These strategies should be contextualized and developed through community engagement. Future research should continue to measure the levels and dimensions of TB stigma among people with TB through behavioral surveillance using standardized tools.
耻辱感是医疗保健的重大障碍，也是导致全球结核病负担的一个因素。然而，发展中国家关于结核病耻辱感的信息匮乏。我们旨在描述、测量和探究柬埔寨结核病患者中结核病耻辱感的决定因素。
我们于2019年2月至8月采用三角收敛设计开展了一项混合方法研究，即对结核病患者进行横断面调查（n = 730）并进行嵌套式深入访谈（n = 31）。定量数据采用描述性统计和广义线性回归模型进行分析。定性记录采用主题分析法进行分析。
分别有56%和51%的参与者经历了自我耻辱感和社区感知到的耻辱感。我们发现农村居民、对结核病传播方式的了解以及知道任何人都可能感染结核病与更高水平的自我耻辱感和社区感知到的耻辱感相关。结核病症状知识得分较高与自我耻辱感和社区耻辱感均呈负相关。主题分析揭示了经历耻辱感的描述、故意与他人保持距离和隐瞒结核病诊断的行为以及尴尬和羞耻的感受。
结核病耻辱感普遍存在，这表明有必要在国家结核病应对措施中纳入减少耻辱感的策略。这些策略应因地制宜，并通过社区参与来制定。未来的研究应继续使用标准化工具通过行为监测来测量结核病患者中结核病耻辱感的水平和维度。
