The Tuberculosis Behavioral and Social Science Research Forum
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
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
- Health education strategies, such as culturally appropriate
interventions to increase accurate TB knowledge and reduce TB-related
- 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.
here for slideset of presentation
Released October 2008
Centers for Disease Control and Prevention
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
Division of Tuberculosis Elimination - http://www.cdc.gov/tb
Please send comments/suggestions/requests
CDC/Division of Tuberculosis Elimination
Communications, Education, and Behavioral Studies Branch
1600 Clifton Rd., NE - Mailstop E-10, Atlanta, GA 30333