The Tuberculosis Behavioral and Social Science Research Forum Proceedings
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Section II. Presentations and Panel Discussions
Preliminary Results from the Tuberculosis Behavioral and Social Science Literature Review
Cathy Rawls, M.P.H., C.H.E.S.
Association of Schools of Public Health Fellow, Communications, Education, and Behavioral Studies Branch, Division of TB Elimination, Centers for Disease Control and Prevention
Cristina Booker, M.P.H.
Analyst, Public Health Applications and Research Area, Abt Associates, Inc.
Day 1, Morning Session
One element of DTBE’s development of a research agenda includes a comprehensive review of TB behavioral and social science literature. Ms. Rawls and Ms. Booker presented preliminary results from the literature review, which was still in progress at the time of the Forum.
DTBE staff conducted a search in OVID across five databases (CINAHL, Embase, Medline, PsycInfo and Sociofile). This search identified literature that addresses behavioral, sociological, and cultural factors affecting TB prevention and treatment among affected populations and health care providers. General inclusion criteria used in this process were as follows:
- TB research that used social science methods or applied social science theory or concepts;
- Published works (including scientific, peer-reviewed literature, review articles, book chapters, and meta-analyses);
- Literature published after 1980; and
- Literature published in the English language that presents data or information for the United States or other countries.
A team of DTBE staff and contractors from Abt Associates reviewed and abstracted 175 articles that were identified for inclusion. To ensure consistency, the team created data abstraction tools for obtaining relevant information from the literature. Multiple reviewers conducted joint article reviews to ensure inter-rater reliability. Key items abstracted from the literature included study descriptions such as study design, objectives, theoretical basis, sampling design, data collection methods, target population, geographic location, structural setting, and quantitative and qualitative analysis; key findings; limitations; conclusions; and recommendations.
Ms. Rawls and Ms. Booker presented preliminary analysis on article types (e.g., research, evaluation, or non-research); broad issues addressed in the literature (e.g., patient adherence; provider adherence; cultural and social domains, including knowledge, attitudes, and beliefs; health-seeking behaviors; structural influences; and other domains); and geographic areas and populations covered. They also identified overarching themes that emerged from authors’ conclusions and recommendations, including the following areas to be addressed by future TB research or practice:
- Underlying social or cultural factors associated with TB, such as poverty and patients’ health beliefs;
- Health care-seeking behavior, such as health care-seeking delays related to stigma and length of treatment;
- Patient-related adherence issues, such as patient-identified barriers and facilitators to adherence;
- Provider-related adherence issues, such as diagnosis and treatment delays;
- Health education strategies, such as culturally appropriate interventions to increase accurate TB knowledge and reduce TB-related prejudices;
- TB control and eradication strategies, including novel and coordinated approaches that involve other health services and diverse types of providers; and
- Resource and funding allocations, including increased resources for interdisciplinary research and continued support for public health TB programs.
Continued activities for the TB behavioral and social science literature review will include a review of 100 additional articles and a database consisting of all the article reviews.