Macdonald Stephen H-F, France Nadine Ferris, Hodgson Ian, Ali Fadhil, Dewi Christa, Abdurrakhman Iman, Runtu Yeremia Mozart, Juan Alva, Sugiharto Jhon, Byrne Elaine, Conroy Ronan M
School of Medicine, University of Limerick, Limerick, V94 T9PX, Ireland.
Beyond Stigma, 18A Redleaf Business Park, Turvey Avenue, Donabate, Co., Dublin, Ireland.
BMC Glob Public Health. 2024 Jun 1;2(1):31. doi: 10.1186/s44263-024-00062-5.
Self-stigma among people who have tuberculosis (TB) can contribute to non-adherence to medication and disengagement from care. It can manifest in feelings of worthlessness, shame, and guilt, leading to social withdrawal and disengagement from life opportunities. Self-stigma may also affect families of those who have TB, or healthcare workers who treat them. However, few interventions addressing TB self-stigma exist to date.
We piloted the delivery of a toolkit of psychosocial interventions using a "training-of-trainers" approach with six staff members of a TB-focused NGO (Non-Governmental Organisation) and partner organisations in Jakarta, Indonesia. These trainers could then disseminate the toolkit among community partner organisations. Local staff involvement throughout the study supported translation and adaptation to enhance cultural and language appropriateness. Over a 2-day training-of-trainers workshop, the NGO staff were familiarised with the mode of delivery of the toolkit, which they then delivered via a four-day participatory workshop with 22 people who have TB/TB survivors, who were representatives of partner organisations working among communities affected by TB.
The newly-trained local facilitators delivered the toolkit to the participants, who self-reported significant increases in knowledge and efficacy around TB self-stigma post-intervention compared to baseline (Z = 1.991, p = 0.047, Wilcoxon signed-rank test). The participants' levels of self-compassion were also significantly higher post-workshop (Z = 2.096, p = 0.036, Wilcoxon signed-rank test); however, these effects were not maintained at 3-month timepoint. There was also a significant increase post-workshop in one of the participants' Ryff dimensions of psychological wellbeing, that of positive relationships with others (Z = 2.509, p = 0.012, Wilcoxon signed-rank test) but this was also not maintained at the 3-month timepoint.
The observed changes in recipients' self-reported levels of knowledge and efficacy, self-compassion, and psychological wellbeing may warrant further investigation into the best modalities for toolkit delivery (frequency, dose, duration) and support for individuals as they progress through the TB treatment journey.
结核病患者的自我污名化会导致不坚持服药以及脱离治疗。它表现为无价值感、羞耻感和内疚感，导致社交退缩以及放弃生活机会。自我污名化也可能影响结核病患者的家人或治疗他们的医护人员。然而，迄今为止，针对结核病自我污名化的干预措施很少。
我们采用“培训培训者”的方法，向印度尼西亚雅加达一家专注于结核病的非政府组织（NGO）及其合作伙伴组织的六名工作人员试点提供一套心理社会干预工具包。这些培训者随后可以在社区合作伙伴组织中传播该工具包。在整个研究过程中，当地工作人员的参与支持了翻译和调整，以提高文化和语言的适宜性。在为期两天的培训培训者研讨会上，该非政府组织的工作人员熟悉了工具包的交付方式，然后他们通过为期四天的参与式研讨会，向22名结核病患者/结核病幸存者（他们是在受结核病影响社区工作的合作伙伴组织的代表）进行了交付。
新培训的当地协调员向参与者提供了该工具包，与基线相比，参与者自我报告称干预后关于结核病自我污名化的知识和效能有显著提高（Z = 1.991，p = 0.047，Wilcoxon符号秩检验）。参与者的自我同情水平在研讨会后也显著更高（Z = 2.096，p = 0.036，Wilcoxon符号秩检验）；然而，这些效果在3个月的时间点上没有得到维持。研讨会后，参与者心理健康的Ryff维度之一，即与他人的积极关系，也有显著增加（Z = 2.509，p = 0.012，Wilcoxon符号秩检验），但这在3个月的时间点上也没有得到维持。
观察到的接受者自我报告的知识和效能水平、自我同情和心理健康方面的变化，可能需要进一步研究工具包交付的最佳方式（频率、剂量、持续时间），以及在个体结核病治疗过程中为他们提供支持。
