Table 3 Pathways to impact of TB-stigma interventions
References | Intervention format | Outcomes | Challenges of the intervention | Reported pathways and impact of the intervention to reduce stigma |
|---|---|---|---|---|
Population: people with TB | ||||
Macq et al. 2008 [28] | TB clubs Patient-centred home visits | Statistically significant difference between internalised stigma scores 2 months following intervention implementation but no difference in scores 15 days following intervention implementation | Different intervention across all nine municipalities Geographical challenges for participants living long distances from others | Self-help groups strengthened relationships between people with TB who took part. Home visits improved the relationship between HCWs and people with TB and were perceived to improve the confidence of people with TB |
Demissie et al. 2003 [29] | TB clubs | Anticipated and internalised stigma in people with TB was reduced People with TB were not scared of a diagnosis of TB, removed any myths about TB treatment, communication around TB between community members improved | None identified | Regular meetings meant patients gained support from each other to adhere to treatment and share information about the process of the treatment and TB, which improved communication and reduced isolation. This was shown to reduce anticipated and internalised stigma |
Acha et al. 2007 [30] | Psychosocial support groups | Internalised stigma was reduced Improved confidence of participants and improved knowledge of TB | Difficulties in recruiting qualified group facilitators. Logistical difficulties: finding meeting space, attendance, and delays Lack of experience with asking questions associated with social stigma | Support groups improved attitude towards disease and improved confidence, which reduced stigma |
Wilson et al. 2016 [33] | Educational video | Improvement in knowledge and understanding of TB and its treatment. Improved patient adherence to treatment. Reduction in fear and stigma of TB | Not effective in busy clinics (video couldn’t be heard). Technical problems: electrical plugs, broken DVD player | Improved ‘curative’ knowledge (e.g., understanding that TB was a curable disease) reduced misconceptions, which reduced stigma |
Chalco et al. 2006 [31] | Individualised emotional support from nurses | Stigma was discussed with nurses to fight stigma and nurses educated people with TB and help to reduce social prejudices. Stigma reduction was not evaluated | Very small group of nurses, thus implementation in a larger area could be difficult. Potential for redirecting nurses away from other roles | Nurses educated and informed family and community members. This group then became more knowledgeable about TB which reduced stigma |
Bond et al. 2017 [26] | Household counselling intervention | Stigma scale was developed No statistically significant reduction in TB-Stigma and TB prevalence in the community | None identified | The suggested theoretical pathways by which stigma was reduced was that the community felt supported by counselling intervention. This led to empowerment and changes to norms and behaviours, which in turn reduced stigma |
Population: Healthcare workers | ||||
Wu et al. 2009 [34] | Nationwide TB training workshops | TB-stigma towards people with TB was reduced significantly. TB knowledge was significantly improved across participants except those with a history of TB. No correlation between increase in TB knowledge and reduction in TB-Stigma | Maintenance of the quality of the intervention across a large, diverse country was difficult | Education workshops caused a shift towards a positive attitude towards TB control which reduced TB-Stigma |
Sommerland et al. 2020 [24] | Workshop and social marketing campaign to HCWs | External stigma—measured by questionnaire—was intended to be reduced after intervention | Professional rank, position and social status could intersect with anti- TB-stigma communication. Thus, addressing other power will be useful for further intervention | The intervention was based on Diffusion of Innovations theory. HCWs who were trained were expected to spread knowledge and messages about TB-Stigma in their workplace and to make a substantial impact across the hospitals |
Population: public | ||||
Balogun et al. 2015 [32] | 10 community volunteers trained to provide community education on TB | Intended outcome was to reduce anticipated stigma. Actual outcome: TB-Stigmatising attitude worsened—more people had a negative attitude towards people with TB following the intervention as misconceptions were not eliminated The other outcome measure, mean knowledge score, improved | Not all ethnic tribes were represented It was challenging to keep community volunteers motivated throughout the intervention period as it was not a paid job | Incomplete education and superficial information on TB in pamphlets led to misconceptions within community which causes changes in TB-stigma |
Croft and Croft 1999 [27] | Health education programme | Lower levels of stigma in the union with the enhanced education programme | Boroshoshi Union was visited less as it was not easily accessible. Communities differed significantly thus the education programme might not have been acceptable to all | Education and removal of misconceptions improved community attitudes which reduced stigma |
Idris et al. 2020 [25] | Education programme: lecture, quiz, small group discussions, poster, and booklets | Increasing knowledge and practice, and reducing stigma scores, which statistically significant compared to the control group | Evaluation of the education program was within a short period (for weeks). The program would face challenge for scaling up to a wider context with multiple ethnic groups | Increasing TB knowledge to reduce stigma |