Characterizing and Measuring Tuberculosis Stigma in the Community: A Mixed-Methods Study in Cambodia

Area of Science:

• Public Health
• Social Science
• Infectious Disease Epidemiology

Background:

• Stigma significantly hinders healthcare access and exacerbates the global burden of tuberculosis (TB).
• Limited data exists on TB stigma in developing nations, particularly in Cambodia.
• This study addresses the knowledge gap by characterizing and measuring TB stigma in Cambodia.

Purpose of the Study:

• To characterize and measure tuberculosis stigma among individuals diagnosed with TB in Cambodia.
• To identify determinants associated with TB stigma in the Cambodian context.
• To explore the lived experiences of stigma among people with TB.

Main Methods:

• A mixed-methods approach combining a cross-sectional survey (n=730) and in-depth interviews (n=31).
• Quantitative data analyzed using descriptive statistics and generalized linear regression.
• Qualitative data analyzed through thematic analysis.

Main Results:

• Over half of participants experienced self-stigma (56%) and perceived community stigma (51%).
• Rural residence, knowledge of TB transmission, and general TB susceptibility were linked to higher stigma levels.
• Greater knowledge of TB symptoms correlated with lower self-stigma and perceived community stigma.

Conclusions:

• Tuberculosis stigma is highly prevalent in Cambodia, necessitating integrated stigma-reduction strategies within national TB control programs.
• Stigma reduction initiatives should be context-specific and developed through active community engagement.
• Ongoing behavioral surveillance using standardized tools is recommended to monitor TB stigma levels and dimensions.