Don't forget the bigger picture : The impact of societal issues on a community‐based TB programme, Swaziland

Purpose – The purpose of this paper is to explore the wider societal issues that can impact on the success of a TB programme. Design/methodology/approach – The paper is a qualitative study of the experiences of people involved in a community‐based DOTS programme in Lubombo, Swaziland, involving patients, DOT treatment supporters, clinic nurses and other key informants. Findings – The paper finds that study participants spontaneously raised two main societal issues, which had major impact on the success of the TB programme: health beliefs and poverty. It is seen that health beliefs can have a major impact on treatment‐seeking behaviour and outcomes of TB treatment. Problems related to poverty were of two main types: insufficient funds to attend for review, and lack of food whilst on TB treatment. Originality/value – This paper discusses why these issues, although strictly outside the remit of the health services, are important factors to consider when implementing TB programmes. It suggests further research that may help break the link between TB and poverty (particularly relating to food insecurity) and recommends considering local health beliefs when dealing with individuals and the community. Neither the impact of health beliefs nor the impact of poverty are new ideas, yet these issues tend to be forgotten by quantitative researchers who perhaps understandably focus on issues that may be perceived as being easier to measure. This paper serves to remind one of their importance and to illustrate the value of qualitative research in highlighting them and ensuring that issues that are important to participants are not neglected.