Doctoral Dissertation Research: The Impact of Social Stigma and Associated Behaviors on Women Seeking Treatment for Tuberculosis Infection in Lusaka, Zambia

Suny At Buffalo, Amherst NY

Investigators

Abstract

This doctoral dissertation research project will examine the impact of tuberculosis-related stigma on women's decisions to seek an initial diagnosis and subsequent treatment for the disease. The global burden of tuberculosis (TB), an opportunistic infection, is estimated to be from 30 to 50 percent worldwide and is on the rise, particularly in countries that also have high HIV prevalence. Women throughout the developing world have disproportionately borne the burden of disease-related stigma, and it affects their lives at different scales -- within their families, in their communities and as part of national discourses. As a result, women are less likely to receive treatment for the disease, which hastens the rate of disease transmission and has a deleterious impact on the physical, social, and economic well-being of communities worldwide. The doctoral student will collaborate with ZAMBART Project, a non-governmental organization in Lusaka, Zambia, to examine the role of individual- and community-level intervention strategies that counter TB-related stigma in order to evaluate their effectiveness and the role of social networks in positive health behavior change. A combination of qualitative and quantitative approaches, including ethnographic field research, statistical analysis, and computational models, will be used to explore the relationships among TB-related intervention strategies and behavior change. Questions to be pursued include the following: (1) Do people change their beliefs about TB and TB-infected persons as a result of intervention strategies? (2) Are there "tipping points" in positive behavior outcomes within groups? (3) Are there identifiable groups within social networks that serve as loci for positive behavior change to ripple outward into their communities? Because of the indelible impact of TB in communities, it is important to examine the role of changing family structure and social networks in informing health decision making. In addition, identifying groups of people may be more susceptible to TB-related stigma is the first step in countering misinformation about the disease and infected persons. This project will provide new information and insights regarding how the social and behavioral determinants of disease influence its control. Enhanced understanding of social networks and their role in the diffusion of information and behavior change will assist researchers and policy makers in designing effective public health programs. Results from this project will be of value for those who study the geography of health, mechanisms of decision making, health behavior, policy design and implementation, and social networks. As a Doctoral Dissertation Research Improvement award, this project will provide support to enable a promising student to establish an independent research career.