title: Listening to those on the frontline: service users' experiences of London tuberculosis services.
abstract: OBJECTIVE
  To explore tuberculosis (TB) service users' experiences and satisfaction with care provision.
  
  
  BACKGROUND
  Thirty-nine percent of all new UK TB cases occur in London. Prevalence varies considerably between and within boroughs. Overall, research suggests inadequate control of London's TB transmission; TB has become a health care priority for all London Primary Care Trusts. Service users' experiences and satisfaction with care provision have not been explored adequately previously.
  
  
  METHODS
  A qualitative research design, using semi-structured face-to-face interviews was used. Ten service users, purposively selected in key risk groups across London, were interviewed. All interviews were digitally recorded with users' permission, transcribed verbatim, and analyzed thematically.
  
  
  RESULTS
  Participants were treated in local hospitals for 6-12 months. Treatment was administered by TB nurses to inpatients and outpatients receiving directly observed therapy in consultation with medical staff and home visits for complex cases. Two participants did not realize the importance of compliance. Overall, they were satisfied with many TB services' aspects, communication, and service organization. Early access, low suspicion index amongst some GPs, and restricted referral routes were identified as service barriers. Other improvement areas were information provision on drug side effects, diet, nutritional status, and a few health professionals' attitudes. The effects on people varied enormously from minimal impact to psychological shock; TB also affected social and personal aspects of their life. With regard to further support facilities, some positive views on managed accommodation by TB-aware professionals for those with accommodation problems were identified.
  
  
  CONCLUSIONS
  This first in-depth study of TB service users' experiences across London offers valuable insights into service users' experiences, providing information and recommendations for a strategic framework for TB service organization and delivery. Overall, further research is needed; TB services - local, national, and international - need to be more closely aligned with service users' complex needs.
authors.affiliation: Institute for Leadership and Service Improvement, Faculty of Health and Social Care, London South Bank University, London, UK.
authors.forename: Markella
authors.initials: M
authors.lastname: Boudioni
authors.forename: Susan
authors.initials: S
authors.lastname: McLaren
authors.forename: Ruth
authors.initials: R
authors.lastname: Belling
authors.forename: Leslie
authors.initials: L
authors.lastname: Woods