[Barriers to tuberculosis awareness and screening: a qualitative study in a French department]

The incidence of tuberculosis in Seine-Saint-Denis is considerably higher than the national average. The north-west part of the department is particularly concerned. Screening teams encounter difficulties communicating on the disease, reaching the populations concerned and obtaining their adhesion to the screening proposal. The objective of this study was to identify and elucidate the obstacles to tuberculosis prevention and screening. A qualitative study was conducted based on observation of screening actions in Seine-Saint-Denis and semi-directive interviews with health professionals in charge of screening, community representatives and associations, and individuals from the population concerned. Obstacles to tuberculosis awareness and screening appear to be linked to the way in which screening is organized and implemented, and communication difficulties in relation to this disease. Three major obstacles were identified: the gap between the little attention paid to this disease and the sanitary crisis it can trigger in the event of an epidemic; the unsuitability of communication tools for the target population and their lack of attractiveness; maladjustment of screening actions to the local context. The study highlights the individual and social marginalization of the tuberculosis issue and the mechanisms producing this marginalization. It encourages the development of more interactive communication tools and modes, and increased awareness of the professionals involved in screening about field realities.