title: TB treatment initiation and adherence in a South African community influenced more by perceptions than by knowledge of tuberculosis.
abstract: BACKGROUND
  Tuberculosis (TB) is a global health concern. Inadequate case finding and case holding has been cited as major barrier to the control of TB. The TB literature is written almost entirely from a biomedical perspective, while recent studies show that it is imperative to understand lay perception to determine why people seek treatment and may stop taking treatment. The Eastern Cape is known as a province with high TB incidence, prevalence and with one of the worst cure rates of South Africa. Its inhabitants can be considered lay experts when it comes to TB. Therefore, we investigated knowledge, perceptions of (access to) TB treatment and adherence to treatment among an Eastern Cape population.
  
  
  METHODS
  An area-stratified sampling design was applied. A total of 1020 households were selected randomly in proportion to the total number of households in each neighbourhood.
  
  
  RESULTS
  TB knowledge can be considered fairly good among this community. Respondents' perceptions suggest that stigma may influence TB patients' decision in health seeking behavior and adherence to TB treatment. A full 95% of those interviewed believe people with TB tend to hide their TB status out of fear of what others may say. Regression analyses revealed that in this population young and old, men and women and the lower and higher educated share the same attitudes and perceptions. Our findings are therefore likely to reflect the actual situation of TB patients in this population.
  
  
  CONCLUSIONS
  The lay experts' perceptions suggests that stigma appears to effect case holding and case finding. Future interventions should be directed at improving attitudes and perceptions to potentially reduce stigma. This requires a patient-centered approach to empower TB patients and active involvement in the development and implementation of stigma reduction programs.
authors.affiliation: Erasmus University Rotterdam, Institute of Health Policy & Management, Rotterdam, The Netherlands. cramm@bmg.eur.nl
authors.forename: Jane M
authors.initials: JM
authors.lastname: Cramm
authors.forename: Harry J M
authors.initials: HJ
authors.lastname: Finkenflügel
authors.forename: Valerie
authors.initials: V
authors.lastname: Møller
authors.forename: Anna P
authors.initials: AP
authors.lastname: Nieboer
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D017144:Focus Groups; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000523:psychology* / Q000706:statistics & numerical data; D012044:Regression Analysis; D012494:Sampling Studies; D012959:Socioeconomic Factors; D013019:South Africa; D013240:Stereotyping; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014376:Tuberculosis / Q000628:therapy*; D055815:Young Adult