Tuberculosis stigma as a social determinant of health: a systematic mapping review of research in low incidence countries.
Tuberculosis (TB)-related stigma is an important social determinant of health. Research generally highlights how stigma can have a considerable impact on individuals and communities, including delays in seeking health care and adherence to treatment. There is scant research into the assessment of TB-related stigma in low incidence countries. This study aimed to systematically map out the research into stigma. A particular emphasis was placed on the methods employed to measure stigma, the conceptual frameworks used to understand stigma, and whether structural factors were theorized. Twenty-two studies were identified; the majority adopted a qualitative approach and aimed to assess knowledge, attitudes, and beliefs about TB. Few studies included stigma as a substantive topic. Only one study aimed to reduce stigma. A number of studies suggested that TB control measures and representations of migrants in the media reporting of TB were implicated in the production of stigma. The paucity of conceptual models and theories about how the social and structural determinants intersect with stigma was apparent. Future interventions to reduce stigma, and measurements of effectiveness, would benefit from a stronger theoretical underpinning in relation to TB stigma and the intersection between the social and structural determinants of health.
School of Health Sciences City, University of London Northampton Square London, EC1V 0HB, UK. Electronic address: gill.craig.1@city.ac.uk.
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Craig
McGill International TB Centre, McGill University, Canada; CAPRISMA/MRC-HIV-TB Pathogenesis and Treatment Research Unit, University of KwaZulu Natal, South Africa.
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Daftary
Department of Health, Ethics & Society/Research School CAPHRI Faulty of Health, Medicine & Life Sciences, Maastricht University, The Netherlands; University of Maastricht, The Netherlands.
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Engel
School of Health Sciences City, University of London Northampton Square London, EC1V 0HB, UK.
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O'Driscoll
School of Health Sciences City, University of London Northampton Square London, EC1V 0HB, UK.
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Ioannaki
D035841:Behavioral Research; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D015994:Incidence; D055118:Medication Adherence / Q000523:psychology; D010342:Patient Acceptance of Health Care / Q000523:psychology / Q000706:statistics & numerical data; D011634:Public Health; D064890:Social Determinants of Health / Q000706:statistics & numerical data*; D057545:Social Stigma; D014376:Tuberculosis / Q000188:drug therapy / Q000453:epidemiology* / Q000523:psychology*; D016903:Drug Monitoring
Discrimination; Health care; Low incidence; Marginalization; Migrants; Social determinantsof health; Stigma; Tuberculosis