title: Surveillance or support: The experience of direct observation during tuberculosis treatment.
abstract: Directly observed therapy (DOT) is a cornerstone of tuberculosis (TB) control. DOT has been criticised as paternalistic, but it has also been argued that the interaction with healthcare workers (HWs) can be a source of support for patients. We explored the experience of patients in antituberculosis treatment, with the aim of understanding the balance between surveillance and support from the recipient's point of view. We interviewed 27 patients in Tijuana, Mexico, employing narrative analysis to understand how participants made sense of their illness and their experience of DOT. We found a core narrative of biographic disruption and self-reconstruction, in which HWs helped participants to attribute a less negative meaning to TB. Interviewees accepted DOT's as necessary for other people to avoid treatment abandonment, but felt that in their case it was unnecessary. Only a few felt that DOT represented mistrust on the part of the HWs. We conclude that DOT can be a source of support when it is enacted in a patient-centred way. We discuss whether participants' lack of criticism of DOT is a case of adaptive preference, in the context of a power differential between patient and health system.
authors.affiliation: a Department of Population Studies , El Colegio de la Frontera Norte , Tijuana , Mexico.
authors.forename: Ietza
authors.initials: I
authors.lastname: Bojorquez
authors.affiliation: b Academic direction, El Colegio de la Frontera Norte , Tijuana , Mexico.
authors.forename: Irais
authors.initials: I
authors.lastname: Salazar
authors.affiliation: c Division of Global Public Health , University of California , San Diego , CA , USA.|d Department of Medicine , University of California , San Diego , CA , USA.
authors.forename: Richard S
authors.initials: RS
authors.lastname: Garfein
authors.affiliation: e Secretaría de Salud de Baja California , Tijuana , Mexico.
authors.forename: Paris
authors.initials: P
authors.lastname: Cerecer
authors.affiliation: f Division of Pulmonary, Critical Care and Sleep Medicine , University of California , San Diego , CA , USA.|g Department of Medicine , University of California , San Diego , CA , USA.
authors.forename: Timothy C
authors.initials: TC
authors.lastname: Rodwell
mesh_terms: D000328:Adult; D000368:Aged; D000995:Antitubercular Agents / Q000008:administration & dosage*; D023801:Directly Observed Therapy; D005260:Female; D006282:Health Personnel; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008800:Mexico; D008875:Middle Aged; D026684:Personal Autonomy; D024382:Professional Role; D011369:Professional-Patient Relations; D036301:Qualitative Research; D012944:Social Support; D014376:Tuberculosis / Q000188:drug therapy*; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents
keywords: Directly observed therapy; health services; personal autonomy; social support; tuberculosis