The public defense of Jiraporn Choowong's doctoral thesis in Care Sciences

Datum: 2017-08-31
Tid: 10.00 - 13.00
Plats: Mälardalen university, room Raspen, Eskilstuna

The public defense of Jiraporn Choowong's doctoral thesis in Care Sciences will take place at Mälardalen university, room Raspen, Eskilstuna at 10.00 on Augusti 31.

Title: “Barriers, Enablers and challenges in the practice of directly observed treatment for tuberculosis patients in a local Thai community”.

Serial number: 233.
The faculty examiner is Professor Maria Emmelin, Lund University, and the examining committee consists of docent Asli Kulane, Karolinska Institutet; Docent Mats Jong, Mid Sweden University; Docent Christine Gustafsson, MDH.

Reserve: Professor Eva Johansson, Karolinska Institutet.
Tuberculosis (TB) is a highly transmittable desease which is globally spread, especially in Africa and Asia. The cause of TB, Mycobacterium tuberculosis, has been known for decades. In order to achieve cure the patient must follow intensive and prolonged treatment for at least six months. Discontinued treatment is one of the major obstacles to combating the disease. An interrupted treatment contributes to increased risk of TB transmission, but also resistance to the TB drugs. 
Since 1993, the World Health Organization (WHO) recommends a directly observed treatment (DOT) method to control and promote TB treatment. This means that the medical treatment is under the supervision of another person, mostly healthcare professionals. 
In Thailand the disease and mortality due to TB is high. Targets to stop the spread of TB has not been achieved. There are major regional and local differences in the outcome of the treatment. Demografical, culturel social factors are important. Lack of knowledge and social reasons hinders the people suffering TB to seek care and to adhere the full treatment. 
At local level effective strategies to control and promote patients completing their TB treatment are lacking. When applying DOT in the Thai local community, it is important to understand DOT in practice, what experiences are available among stakeholders in health care and among the people affected.
This thesis focuses on experiences of how DOT is applied in a Thai local community, and which strategies are effective from scientific studies. Experiences of DOT are studied among healthcare providers, DOT observers (healthcare professionals, family members, health workers) and by patients. The results show that lack of TB knowledge and skills among DOT observers, and the fear of stigma among TB patients are significant obstacles. Social belonging and TB patients' positive thinking and self-awareness are considered important conditions for adherence of the treatment. A systematic literature review demonstrated that local strategies based on an empowerment approach will promote the implementation of DOT.
This approach would contribute to strengthening DOT observers in their role and ability to provide relevant support that in turn support TB patients to adhere the TB treatment. The results of this thesis will be useful for Thai policy makers and caregivers to develop strategies that can improve the implementation of DOT in local communities and enable patient to comply with the TB treatment.