Barriers and facilitators to integrating depression care in tuberculosis services in South Asia: a multi-country qualitative study.
Adolescent
Adult
Aged
Female
Humans
Male
Middle Aged
Young Adult
Bangladesh
/ epidemiology
Delivery of Health Care, Integrated
/ organization & administration
Depression
/ diagnosis
Health Personnel
/ psychology
Health Services Accessibility
India
/ epidemiology
Pakistan
/ epidemiology
Qualitative Research
Tuberculosis
/ psychology
Health Knowledge, Attitudes, Practice
Social Stigma
Financial Stress
Caregivers
/ psychology
Patients
/ psychology
Bangladesh
Depression
India
Integrated care
LMIC
Pakistan
Tuberculosis
Journal
BMC health services research
ISSN: 1472-6963
Titre abrégé: BMC Health Serv Res
Pays: England
ID NLM: 101088677
Informations de publication
Date de publication:
31 Jul 2023
31 Jul 2023
Historique:
received:
08
12
2022
accepted:
03
07
2023
medline:
2
8
2023
pubmed:
1
8
2023
entrez:
31
7
2023
Statut:
epublish
Résumé
Depression is common among people with tuberculosis (TB). The condition is typically unrecognised or untreated despite available and effective treatments in most low- and middle-income countries. TB services in these countries are relatively well established, offering a potential opportunity to deliver integrated depression screening and care. However, there is limited evidence on how such integration could be achieved. This study aimed to understand the barriers and facilitators to integrate depression care in TB services. We conducted nine workshops with 76 study participants, including people with TB, their carers, and health service providers in Bangladesh, India, and Pakistan, seeking views on integrating depression care into TB clinics. We used a deductive thematic approach to analyse the translated transcripts of audio recordings, contemporaneous notes made during workshops for Bangladesh and India and workshop reports for Pakistan. Using the SURE (Supporting the Use of Research Evidence) thematic framework, we extracted and categorised barriers and facilitators into various domains. Reported barriers to integrating depression care in TB services included lack of knowledge about depression amongst patients and the staff, financial burden, and associated stigma for people with TB and their carers. Government buy-in and understanding of how to identify and screen for depression screening were potential facilitators reported. Additionally, breaking through mental health stigma and providing the additional resources required to deliver this service (human resources and consultation time) were essential for integrating depression and TB care. Depression is a common condition found among people with TB, requiring early identification among people with TB. Integrating depression care into Tb services by health workers requires the availability of political support and the provision of resources.
Sections du résumé
BACKGROUND
BACKGROUND
Depression is common among people with tuberculosis (TB). The condition is typically unrecognised or untreated despite available and effective treatments in most low- and middle-income countries. TB services in these countries are relatively well established, offering a potential opportunity to deliver integrated depression screening and care. However, there is limited evidence on how such integration could be achieved. This study aimed to understand the barriers and facilitators to integrate depression care in TB services.
METHODS
METHODS
We conducted nine workshops with 76 study participants, including people with TB, their carers, and health service providers in Bangladesh, India, and Pakistan, seeking views on integrating depression care into TB clinics. We used a deductive thematic approach to analyse the translated transcripts of audio recordings, contemporaneous notes made during workshops for Bangladesh and India and workshop reports for Pakistan. Using the SURE (Supporting the Use of Research Evidence) thematic framework, we extracted and categorised barriers and facilitators into various domains.
RESULTS
RESULTS
Reported barriers to integrating depression care in TB services included lack of knowledge about depression amongst patients and the staff, financial burden, and associated stigma for people with TB and their carers. Government buy-in and understanding of how to identify and screen for depression screening were potential facilitators reported. Additionally, breaking through mental health stigma and providing the additional resources required to deliver this service (human resources and consultation time) were essential for integrating depression and TB care.
CONCLUSIONS
CONCLUSIONS
Depression is a common condition found among people with TB, requiring early identification among people with TB. Integrating depression care into Tb services by health workers requires the availability of political support and the provision of resources.
Identifiants
pubmed: 37525209
doi: 10.1186/s12913-023-09783-z
pii: 10.1186/s12913-023-09783-z
pmc: PMC10391993
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
818Subventions
Organisme : National Institute for Health and Care Research
ID : NIHR (17/63/130)
Informations de copyright
© 2023. The Author(s).
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