Fuady Ahmad, Fitriangga Agus, Sugiharto Agus, Arifin Bustanul, Yunita Ferdiana, Yani Finny Fitry, Nasution Helmi Suryani, Putra I Wayan Gede Artawan Eka, Rauf Saidah, Mansyur Muchtaruddin, Wingfield Tom
Department of Community Medicine, Faculty of Medicine, Universitas Indonesia, Pegangsaan Timur No 16 Jakarta, 10310, Indonesia.
Department of Community Medicine, Faculty of Medicine, Universitas Tanjungpura, Pontianak, 78124, Indonesia.
Wellcome Open Res. 2022 Dec 7;7:42. doi: 10.12688/wellcomeopenres.17645.2. eCollection 2022.
Tuberculosis (TB)-related stigma remains a key barrier for people with TB to access and engage with TB services and can contribute to the development of mental illnesses. This study aims to characterise stigmatisation towards people with TB and its psychosocial impact in Indonesia. This study will apply a sequential mixed method in two main settings: TB services-based population (setting 1) and workplace-based population (setting 2). In setting 1, we will interview 770 adults with TB who undergo sensitive-drug TB treatment in seven provinces of Indonesia. The interview will use the validated TB Stigma Scale questionnaire, Patient Health Questionnaire-9, and EQ-5D-5L to assess stigma, mental illness, and quality of life. In Setting 2, we will deploy an online questionnaire to 640 adult employees in 12 public and private companies. The quantitative data will be followed by in-depth interview to TB-related stakeholders. CAPITA will not only characterise the enacted stigma which are directly experienced by people with TB, but also self-stigma felt by people with TB, secondary stigma faced by their family members, and structural stigma related to the law and policy. The qualitative analyses will strengthen the quantitative findings to formulate the potential policy direction for zero TB stigma in health service facilities and workplaces. Involving all stakeholders, i.e., people with TB, healthcare workers, National Tuberculosis Program officers, The Ministry of Health Workforce, company managers, and employees, will enhance the policy formulation. The validated tool to measure TB-related stigma will also be promoted for scaling up to be implemented at the national level. To improve patient-centered TB control strategy policy, it is essential to characterise and address TB-related stigma and mental illness and explore the needs for psychosocial support for an effective intervention to mitigate the psychosocial impact of TB.
结核病（TB）相关的污名化仍然是结核病患者获得和参与结核病服务的关键障碍，并可能导致精神疾病的发展。本研究旨在描述印度尼西亚对结核病患者的污名化情况及其心理社会影响。本研究将在两个主要场所采用序贯混合方法：基于结核病服务的人群（场所1）和基于工作场所的人群（场所2）。在场所1，我们将采访印度尼西亚七个省份中正在接受敏感药物结核病治疗的770名成年结核病患者。访谈将使用经过验证的结核病污名量表问卷、患者健康问卷-9和EQ-5D-5L来评估污名、精神疾病和生活质量。在场所2，我们将向12家公共和私营公司的640名成年员工发放在线问卷。定量数据之后将对与结核病相关的利益相关者进行深入访谈。该研究不仅将描述结核病患者直接经历的实际污名，还将描述结核病患者感受到的自我污名、其家庭成员面临的次生污名以及与法律和政策相关的结构性污名。定性分析将强化定量研究结果，以制定在卫生服务设施和工作场所实现零结核病污名的潜在政策方向。让所有利益相关者参与，即结核病患者、医护人员、国家结核病项目官员、卫生部工作人员、公司经理和员工，将加强政策制定。还将推广经过验证的衡量结核病相关污名的工具，以便扩大规模在国家层面实施。为了改进以患者为中心的结核病控制战略政策，必须描述和解决与结核病相关的污名和精神疾病，并探索心理社会支持的需求，以进行有效干预，减轻结核病的心理社会影响。
