Department of Maternal-Infant and Public Health Nursing, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil.
Department of Nursing, Federal University of Catalão, Catalão, Goiás, Brazil.
PLoS One. 2021 Apr 9;16(4):e0249822. doi: 10.1371/journal.pone.0249822. eCollection 2021.
This study aimed to analyze the discourses of patients who were diagnosed with multidrug-resistant tuberculosis, the perception of why they acquired this health condition and barriers to seeking care in a priority city in Brazil during the COVID-19 pandemic. This was an exploratory qualitative study, which used the theoretical-methodological framework of the Discourse Analysis of French matrix, guided by the Consolidated Criteria for Reporting Qualitative Research. The study was conducted in Ribeirão Preto, São Paulo, Brazil. Seven participants were interviewed who were undergoing treatment at the time of the interview. The analysis of the participants' discourses allowed the emergence of four discursive blocks: (1) impact of the social determinants in the development of multidrug-resistant tuberculosis, (2) barriers to seeking care and difficulties accessing health services, (3) perceptions of the side effects and their impact on multidrug-resistant tuberculosis treatment, and (4) tuberculosis and COVID-19: a necessary dialogue. Through discursive formations, these revealed the determinants of multidrug-resistant tuberculosis. Considering the complexity involved in the dynamics of multidrug-resistant tuberculosis, advancing in terms of equity in health, that is, in reducing unjust differences, is a challenge for public policies, especially at the current moment in Brazil, which is of accentuated economic, political and social crisis. The importance of psychosocial stressors and the lack of social support should also be highlighted as intermediary determinants of health. The study has also shown the situation of COVID-19, which consists of an important barrier for patients seeking care. Many patients reported fear, insecurity and worry with regard to returning to medical appointments, which might contribute to the worsening of tuberculosis in the scenario under study.
这项研究旨在分析被诊断患有耐多药结核病的患者的话语，分析他们为何会罹患这种疾病，以及在巴西 COVID-19 大流行期间，在优先城市寻求治疗时存在哪些障碍。这是一项探索性的定性研究，使用了法国矩阵话语分析的理论方法框架，并遵循了定性研究报告的综合标准。该研究在巴西圣保罗的里贝朗普雷图进行。采访了 7 名正在接受治疗的参与者。对参与者话语的分析揭示了四个话语块的出现：（1）社会决定因素对耐多药结核病发展的影响；（2）寻求护理的障碍和获取卫生服务的困难；（3）对副作用的看法及其对耐多药结核病治疗的影响；（4）结核病和 COVID-19：必要的对话。通过话语形成，这些揭示了耐多药结核病的决定因素。考虑到耐多药结核病动态的复杂性，在卫生公平方面取得进展，即减少不公正的差异，是公共政策的一项挑战，尤其是在巴西目前经济、政治和社会危机加剧的情况下。还应强调心理社会压力源和缺乏社会支持作为健康的中介决定因素的重要性。该研究还显示了 COVID-19 的情况，这是患者寻求治疗的一个重要障碍。许多患者报告说，他们对重返医疗预约感到恐惧、不安全和担忧，这可能导致研究中结核病的恶化。
