Adherence to tuberculosis care in Canadian Aboriginal populations Part 2: a comprehensive approach to fostering adherent behaviour
Bibliographic record
Abstract
OBJECTIVES: In a 2-part series, the current literature with respect to adherence to tuberculosis care among Canadian Aboriginal populations is reviewed. In the current paper, which comprises part 2 of this review, strategies to remove barriers to TB adherence and to sustain and improve adherence are explored. Study design. Literature review. METHODS: The biomedical and social science literature, including electronic databases (PubMed, PsychINFO, MEDLINE, Native Health Database. Scopus, Social Science Citation Index) were searched and reviewed with regard to relevant studies on adherence to health care, and to tuberculosis care specifically. RESULTS: The majority of published studies of interventions to remove barriers to TB adherence are focused on the health service system and on the individual. The former include enhanced programs of directly observed therapy and directly observed preventive therapy, as well as "permeable" health services that require minimal negotiation. At the personal level, effort must be made to develop a shared knowledge of and care plan for TB, which includes Indigenous and Western scientific health beliefs and practice. The quality of the relationship between health care provider and patient is critical to the outcome of educational efforts that support adherence. Few studies address interventions within the social context, and few have used participatory methodologies in partnership with families and communities. Social supports such as assistance with childcare, transportation and shelter have been shown to be associated with improved adherence to care for other conditions. TB programs may wish to use techniques used in other health programs, such as the identification of patient "sponsors" or mentors, or the use of verbal and/or written "contracts." CONCLUSIONS: Many of the interventional studies addressing health system barriers to TB adherence are grounded in the view that the problem rests with the patient. What is required is an approach that is responsive to the patient's needs while holding the patient to his or her personal and societal responsibilities. Adherence to therapy is unlikely to improve in a substantial way unless Indigenous beliefs about causation and care are incorporated into a program which has meaning for the patient.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.001 |
| Bibliometrics | 0.002 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".