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Running Head: THE EFFECTS OF SOCIAL STIGMA IN THE COMPLIANCE AMONG TUBERCULOSIS PATIENTS IN THE COMMUNITY

ABSTRACT Tuberculosis (TB) is an infection caused by bacteria that usually affect the lungs. These bacteria, called Mycobacterium tuberculosis, can be passed on to another person through tiny droplets spread by coughing and sneezing. The study aims to find the effects of social stigma in the compliance among tuberculosis patients. Thus, this will give the health care providers insights into the effects of social stigma and will aid in providing interventions that will strengthen the compliance of TB patients. It is hoped that this study will help health care providers as well as the patients in understanding TB as a curable disease. In addition, the study aims to find answers in the following questions: (a.)Is there a significant relationship in the perception of the public and in the compliance of the tuberculosis patient? (b.)What are the perceived effects of social stigma in patients acceptance of his/her condition? (c.)Are there any effects of social stigma in the early diagnosis and treatment of tuberculosis? The study will be conducted in Tuguegarao City, in partnership with the City Health Office.

THE EFFECTS OF SOCIAL STIGMA IN THE COMPLIANCE AMONG TUBERCULOSIS PATIENTS IN THE COMMUNITY

INTRODUCTION Tuberculosis (TB) is a major cause of illness and death worldwide, especially in Asia and Africa. Globally, 9.2 million new cases and 1.7 million deaths from TB occurred in 2006, of which 0.7 million cases and 0.2 million deaths were in HIV-positive people. It is estimated that nearly half of the 1.7 billion people in the region have been infected with tuberculosis. The South-East Asia Region, with 4.97 million TB cases, carries over one-third of the global burden of TB. In the Philippines, Tuberculosis (TB) is a major public health problem. An estimated 260 000 people developed active TB in 2011, of these around 25% were not detected or notified. The TB mortality rate remains high at 29 per 100 000 population. In addition, TB is the number six leading cause of death, with 73 Filipinos dying every day of TB. The data collected shows that there is an alarming incidence of TB despite the presence drugs that can cure it. Treatment of active TB involves taking multiple anti-TB drugs 5 days per week, for at least 6 months (Rieder 2002: 10-11). TB treatment services are offered free of charge at the primary level in all public sector facilities, yet poor completion rates continue to rise. Many factors may lead to poor completion rates. One identified factor is being stigmatized by the society. Stigmatization occurs when people are given a negative social label that identifies them as deviant, not because their behaviour violates norms but because they have personal or social characteristics that lead others to exclude them. (Mason et al., 2001; Johnson, 1995). In some setting TB is considered to be an inherited and/or incurable disease associated with unclean or undesirable habits or livelihoods. These perceptions are often reinforced in lower socio economic status group by impaired access to information and when the costs of reaching diagnosis and cure are out of reach. Widespread

THE EFFECTS OF SOCIAL STIGMA IN THE COMPLIANCE AMONG TUBERCULOSIS PATIENTS IN THE COMMUNITY perception to this associated stigma, leads to fear of loss of employment and income, social exclusion and diminished marriage prospect (Thorson A, 2001). Some of the patients also revealed that they go to the DOTS center which is farther from their home so that nobody knows that they are taking TB drugs(Aryal S, 2012). Goffman (1990) distinguished three different types of stigma. First there are abominations of the body, the various physical deformities. Next there are blemishes of individual character perceived as weak will, domineering or unnatural passions, treacherous and rigid beliefs and dishonesty. Finally, there are the tribal stigmas of race, nation and religion, these being stigmas that can be transmitted through lineage and equally contaminate all members of a family. Despite of the presence of the multidrug therapy and the implementation of the direct observe treatment short course that was proven to be effective in dealing with TB, there is still a problem that cause the low compliance on TB patients. Nevertheless, the presence of stigma on TB patients and this factor will either delay treatment or cause relapses of the disease. This study will examine the relationship of stigma on the compliance of TB patients.

THE EFFECTS OF SOCIAL STIGMA IN THE COMPLIANCE AMONG TUBERCULOSIS PATIENTS IN THE COMMUNITY

METHODS RESEARCH DESIGN The researchers made use of the descriptive correlational method. According to Sevilla (1992), the descriptive correlational survey method is designed to determine the extent to which different variables are related to each other in the population of interest. The critical distinguishing characteristic is the effort to estimate a relationship, as distinguished from simple description. Through this, one can ascertain how much variation is caused by one variable in relation with the variation caused by another variable. RESPONDENTS OF THE STUDY The study will be conducted in City Health Office in Tuguegarao City. By random selection, 100 patients registered for DOTS will be selected. RESEARCH TOOL The researchers will use a self-made questionnaire in gathering data pertinent to the study. A letter was formulated explaining the purpose of the study accompanied with a questionnaire. DATA GATHERING PROCEDURE Using the self-made questionnaire, the researcher will use the interview method to elicit information from the selected TB patients. The patients were interviewed at three fixed moments: at the start of the treatment, after 1 month, after 2 months and followed-up until the end of the treatment. During the interviews, based on questionnaires consisting predominantly of

THE EFFECTS OF SOCIAL STIGMA IN THE COMPLIANCE AMONG TUBERCULOSIS PATIENTS IN THE COMMUNITY closed questions and a small number of open questions, information was gathered about the demographical and socio-economic profile of the patients, social support provided by different networks, the patients key values, their knowledge of TB and their perception of the curability of the disease, stigmatization and compliance.

THE EFFECTS OF SOCIAL STIGMA IN THE COMPLIANCE AMONG TUBERCULOSIS PATIENTS IN THE COMMUNITY

PREDICTED RESULTS It is expected that this study will show that stigma have a direct effect on the compliance of TB patients. The study will help health care providers in giving support on patients experiencing problems in complying with treatment due to the stigma of TB in the society. It will also give idea to social workers that they have to be keen in observing TB patients whether there is a presence of stigma in the society. Ultimately, this study will help strengthen the DOTS to be able to cure TB and lessen TB mortality. In the event that stigma dont have any effect on compliance, other factors should be investigated such as the presence of drug resistance or the socio-economic status of a patient.

THE EFFECTS OF SOCIAL STIGMA IN THE COMPLIANCE AMONG TUBERCULOSIS PATIENTS IN THE COMMUNITY

References JOURNALS Aryal S, Badhu A, Pandey S, Bhandari A, Khatiwoda P, Khatiwada P, et al. Stigma related to Tuberculosis among patients attending DOTS clinics of Dharan Municipality.Kathmandu Univ Med J 2012;37(1)48-52. Uplekar M W, Rangan S, Weiss M g, Ogden J, Borgdorff M W, Hudelson P. Attention to gender issues in tuberculosis control. Int J Tuberc Lung Dis 2001; 5: 220224. P. Sukumaran, K.P. Venugopal and Rejoy Simon Manjooran(2002) Retrieved from http:// http://medind.nic.in/ibr/t02/i4/ibrt02i4p205.pdf Rajeswari R, Muniyandi M, Balasubramanian B, Narayanan PR. Perceptions of tuberculosis patients about their physical, mental and social well-being: a field report from south India. Social Science & Medicine 2005; 60:184553. Goffman E : Stigma : notes on the management of spoiled identity. New York Simon & Shuster 1963. Sirinapha X. Jittimanee, Nateniyom S, Kittikraisak W, Burapat C, Akksilp S, Chumpathat N, Sirinak C, Sattayawuthipong W, Varma JK. Social stigma and knowledge of tuberculosis and HIV among patients with both diseases in Thailand. PloS ONE 4(7) 2009;e6360. doi:10.1371/journal.prone.0006360. Rie AV, Sengupta S, Pungrassami P, Balthip Q, Choonuan S, Kasetjaroen Y, et al. Measuring stigma associated with tuberculosis and HIVAIDS in southern Thailand: exploratory and

THE EFFECTS OF SOCIAL STIGMA IN THE COMPLIANCE AMONG TUBERCULOSIS PATIENTS IN THE COMMUNITY confirmatory factor analyses of two new scales. Tropical Medicine and International Health 2008;13(1):21-30. INTERNET World Health Organization [Internet]. Global tuberculosis control 2008. WHO. [Available from:http://www.who.int/entity/tb/publications/global_report/en/index.html] World Health Organization [Internet]. Tuberculosis - TB in South-East Asia Epidemiology. [http://www.searo.who.int/en/ Section10/Section2097/Section2100_10639.htm] BOOKS Brunner and Suddarth (2010) Medical- Surgical Nursing, Volume 1.