O'Mara, Alison; Marrero-Guillamón, Isaac; Jamal, Farah; Lehmann, Angela; Cooper, Chris; Lorenc, Theo; (2011) Tuberculosis evidence review 1: Review of barriers and facilitators. National Institute for Health and Clinical Excellence: London.

Text NICE_2010_Tuberculosis1_Review_of_barriers_and_facilitators.pdf - Submitted Version Access restricted to UCL open access staff Download (2MB) | Request a copy

Abstract

[Extract from the executive summary] 1.1. Introduction This report presents the findings of a systematic review of qualitative evidence on the factors that help or hinder the uptake of TB diagnosis and treatment services by people from hard-to-reach groups. The primary research question for the review was: What factors help or hinder the uptake of TB diagnosis and treatment services by people from hard-to-reach groups, for example, the stigma associated with diagnosis, and how can the barriers be overcome? The secondary research questions were: - How do views vary between different hard-to-reach groups? - What are the views of service providers? 1.2 Methods To locate evidence, a range of databases and websites indexing relevant literature were searched. Study reports were included if they: - had a focus on TB services of any kind; - were conducted in an OECD country; - were published in 1990 or later; - presented data on the views of hard-to-reach people regarding perceptions of or attitudes to TB services; - presented qualitative data; - included data from any hard-to-reach group (hard-to-reach groups include: prisoners; problem drug users or people with alcohol problems; homeless people or people in temporary accommodation; asylum seekers, refugees and recent immigrants; travellers; and sex workers). Only migrant groups of relevance to England were included. Respondents did not necessarily have to be diagnosed with TB; and - were reported in English. The quality of included studies was assessed, and data were extracted, using the standard tools for NICE public health evidence reviews. Study findings were synthesised thematically using a framework adapted from the Health Belief Model because the themes identified in the evidence mapped well onto the model. This is perhaps unsurprising given that the model originally developed in the context of TB screening uptake. 1.3 Findings Twenty-five study reports were included in the review. Of these, nine came from the UK, ten from the USA, and two from Canada. The remaining four studies were from Italy, Norway, New Zealand, and Israel...

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