Bench, bed and beyond: Communication and responsibility in decentralised tuberculosis care

Area of Science:

• Public Health
• Sociolinguistics
• Healthcare Communication

Background:

• South Africa experiences a severe drug-resistant tuberculosis epidemic.
• Effective tuberculosis care is challenged by communication deficits.
• Decentralized care models complicate communication pathways.

Purpose of the Study:

• To explore communication facilitators and barriers in tuberculosis care.
• To analyze communication practices across diagnosis, treatment, discharge, and follow-up.
• To identify communication gaps in decentralized tuberculosis care.

Main Methods:

• Qualitative study conducted at three tuberculosis care sites in South Africa.
• Data collected through 79 interviews, 4 video-recorded patient-healthcare worker interactions, and ethnographic observations.
• Thematic analysis and a qualitative sociolinguistic framework were used for data analysis.

Main Results:

• Communication is complex due to multiple sites and roles in decentralized care.
• Patients often bear the burden of communication, and treatment guidelines are inconsistently applied.
• Confusion and frustration are reported by both patients and healthcare workers.

Conclusions:

• Communication in South African tuberculosis care is fragile.
• Current systems fail to adequately detect communication-related flaws.
• Recommendations include strengthening home-based care, team training, and focusing on communication in monitoring and evaluation.