Behavioural barriers and perceived trade-offs to care-seeking for tuberculosis in the Philippines

ABSTRACT

Effective tuberculosis (TB) treatment has existed for more than 50 years, but TB remains a leading cause of death worldwide and in the Philippines, in part because symptomatic individuals delay or avoid seeking care. Through qualitative interviews in Pampanga, Philippines, we investigated barriers to care-seeking using a behavioural science lens. We found barriers to TB care-seeking to be shaped by: (1) ambiguous symptoms; (2) association of TB risk with lifestyle and habits; (3) expectations of stigma, discrimination, and isolation; (4) short-term costs and long-term financial burden of TB; and (5) visibility of care in public sector facilities. Findings suggest that these barriers are deeply intertwined and that, typically, it is a combination of barriers that holds back a particular symptomatic individual from seeking care, as the barriers influence implicit trade-offs related to health, social, and financial consequences of having TB or another serious illness and of seeking care or not seeking care. The findings suggest avenues for more effectively reaching those with symptoms and their family members to encourage care-seeking by elevating the perceived benefits and putting perceived costs in proper perspective.

KEYWORDS:

• behavioural science
• behavioural economics
• tuberculosis
• stigma
• Philippines

Acknowledgements

This work was made possible by the generous support of the American people through the United States Agency for International Development (USAID) under Breakthrough RESEARCH (cooperative agreement no. AID-OAA-A-17-00018). The contents of this manuscript are the sole responsibility of the authors and do not necessarily reflect the views of USAID or the United States Government.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This work was made possible by the generous support of the American people through the United States Agency for International Development (USAID) under Breakthrough RESEARCH [cooperative agreement no. AID-OAA-A-17-00018].