Surveillance or support: The experience of direct observation during tuberculosis treatment |
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| Authors: | Ietza Bojorquez Irais Salazar Richard S. Garfein Paris Cerecer Timothy C. Rodwell |
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| Affiliation: | 1. Department of Population Studies, El Colegio de la Frontera Norte, Tijuana, Mexico;2. Academic direction, El Colegio de la Frontera Norte, Tijuana, Mexico;3. Division of Global Public Health, University of California, San Diego, CA, USA;4. Department of Medicine, University of California, San Diego, CA, USA;5. Secretaría de Salud de Baja California, Tijuana, Mexico;6. Division of Pulmonary, Critical Care and Sleep Medicine, University of California, San Diego, CA, USA |
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| 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. |
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| Keywords: | Directly observed therapy personal autonomy social support tuberculosis health services |
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