Setting: The core concepts of tuberculosis (TB) control programmes are case-finding (voluntary presentation) and case-holding (compliance for both patient and system). Voluntary presentation and compliance are complex behaviours that depend upon symptom recognition and evaluation, cultural and social influences and enabling factors such as time, money, skills and appropriate/accessible health services. It was hypothesised that cognitive and affective reactions towards TB were based on perceived prevalence, perceived seriousness and perceived social stigma.
Objectives: To ascertain the underlying dimensions that are used when people react cognitively and emotionally to TB, and to determine possible restricting social influence factors on voluntary presentation and case-holding.
Design: A questionnaire was designed to obtain information on background details, perceptions of TB (transmission, prevention, diagnosis and treatment), and a 19-item cognitive/affective scale. 19 trained interviewers administered the questionnaire. Interviews were conducted with 487 black adults (67 TB patients on ambulatory therapy and 420 non-TB community members), from two urban townships in the Transvaal, South Africa.
Results: The majority of respondents were aware of the infectious nature of TB, that it could be cured and the length of treatment. The most problematic issues were isolation for TB sufferers and the harm TB sufferers do to others. Cognitive/affective reactions were similar for TB patients and community members. 10 items out of the 19-item cognitive/affective scale had communality estimates > or = 0.30. 3 factors were extracted. The first factor seemed to combine personal threat (high personal and family risk) with social rejection by the immediate family and community for TB sufferers. Factor 2 had strong overtones of social stigma, with its emphasis on dirt, poverty and poor nutrition. Factor 3 rejected alcohol and tobacco consumption as causal agents of TB.
Conclusions: The predominant cognitive/affective reactions towards TB were personal threat, social rejection and social stigma, providing partial support for the hypothesis. The powerful force of social rejection and social stigma cannot be underestimated. These inhibiting factors require urgent attention to improve voluntary presentation and compliance behaviour.