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Abstract
Objectives Early diagnosis and timely treatment are key elements of a successful healthcare system. We assessed the role of socioeconomic and cultural norms in accelerating or decelerating uptake and utilisation of health technologies into policy and practice.
Setting Secondary and tertiary level healthcare facilities (HCFs) in three East African countries. Level of HCF was selected based on the WHO recommendation for implantation of tuberculosis (TB) molecular diagnostics.
Participants Using implementation of TB diagnostics as a model, we purposively selected participants (TB patients, carers, survivors, healthcare practitioners, community members, opinion leaders and policy-makers) based on their role as stakeholders. In-depth interviews, key informant interviews and focus group discussions were held to collect the data between 2016 and 2018. The data were transcribed, translated, coded and analysed by thematic-content analysis.
Results A total of 712 individuals participated in the study. Socioeconomic and cultural factors such as poverty, stigma and inadequate knowledge about causes of disease and available remedies, cultural beliefs were associated with low access and utilisation of diagnostic and treatment tools for TB. Poverty made people hesitate to seek formal healthcare resulting in delayed diagnosis and resorting to self-medication and cheap herbal alternatives. Fear of stigma made people hide their sickness and avoid reporting for follow-up treatment visits. Inadequate knowledge and beliefs were fertile ground for aggravated stigma and believing that diseases like TB are caused by spirits and thus cured by spiritual rituals or religious prayers. Cultural norms were also the basis of gender-based imbalance in accessing care, ‘I could not go to hospital without my husband’s permission’, TB survivor.
Conclusion Our findings show that socioeconomic and cultural factors are substantial ‘roadblocks’ to accelerating the uptake and utilisation of diagnostic and treatment tools. Resolving these barriers should be given equal attention as is to health system barriers.
- diagnostic microbiology
- molecular diagnostics
- health policy
- tuberculosis
- public health
Data availability statement
Data are available on reasonable request. Extra data are available on request and meeting the confidentiality and use of data requirements signed between authors and participants. Email ws31@st-andrews.ac.uk of University of St Andrews to register your request.
This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.
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Data availability statement
Data are available on reasonable request. Extra data are available on request and meeting the confidentiality and use of data requirements signed between authors and participants. Email ws31@st-andrews.ac.uk of University of St Andrews to register your request.
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Supplementary Data
This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.
Supplementary Data
This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.
Footnotes
EFM and FO contributed equally.
Correction notice This article has been corrected since it was published. Affiliation of Dr. Augustus Aturinde has been updated.
Contributors Study design: WS, SHG, NEN, EA, BMm and MJ. Data collection and collation: EFM, FO, ESS, BMi, SM, HM, KK, AL and IM. Drawings. AA and WS; Data analysis: EFM, FO, ESS, HM. Manuscript drafting: EFM, ESS, FO and WS; Manuscript review: all coauthors.
Funding The study was funded by the European and Developing Countries Clinical Trials Partnership (EDCTP), grant TWENDE-EDCTP-CSA-2014-283.
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Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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