Peer-reviewed article
"They hide because they fear": Barriers and opportunities for tuberculosis control in rural Indonesia through the PRECEDE-PROCEED lens.
Lufianti A, Widjanarko B, Pamungkasari EP, Probandari A ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study explored barriers to tuberculosis control in rural Indonesia using qualitative research with 18 key informants and 11 focus group participants. The research identified persistent TB misconceptions, stigma, structural barriers like poor housing and inadequate ventilation, weak health systems, and limited community engagement as interconnected obstacles to effective TB control. Young people and schools were identified as underutilised resources that could help address these barriers. The findings suggest a need for community-based youth empowerment interventions tailored to rural Indonesian contexts.
Key points
- TB stigma is characterised by fear, shame, and social avoidance, with people hiding from treatment due to these social factors
- Structural barriers include inadequate housing, poor ventilation, human resource shortages, and low treatment-preventive therapy coverage
- Barriers interact across multiple domains, with stigma amplifying system weaknesses and undermining treatment supervision
- Young people and educational institutions are currently underutilised as potential agents of change for TB control
- Inconsistent treatment supervision and limited multi-stakeholder involvement, particularly absence of schools, contribute to programme gaps
Limitations
This is a qualitative study based on semi-structured interviews and focus group discussions conducted in Central Java; it does not test interventions or measure outcomes, so findings may not be generalisable to other regions of Indonesia or represent quantified prevalence of identified barriers.
Abstract
Background Tuberculosis (TB) remains a significant public health challenge in rural Indonesia, where structural barriers, limited health literacy, and persistent stigma hinder effective disease control. Systematic exploration of contextual obstacles and opportunities for youth empowerment interventions in TB control remains limited. Objective This study explored contextual barriers and opportunities to enhance TB awareness and community involvement in rural Indonesia, using the PRECEDE-PROCEED model to identify predisposing, enabling, and reinforcing factors influencing TB control behaviours. Methods An exploratory qualitative study using a phenomenological approach was conducted in Central Java, Indonesia (February-August 2024). Data were collected through semi-structured interviews with 18 key informants and two focus group discussions with 11 participants. Reflexive thematic analysis was conducted using NVivo 12, with trustworthiness ensured through prolonged engagement, triangulation, member checking, and COREQ adherence. Results Nine themes emerged across three domains. Predisposing factors included persistent TB misconceptions and stigma characterised by fear, shame, and social avoidance. Enabling factors comprised structural barriers (inadequate housing, poor ventilation), weaknesses in TB detection (human resource shortages, low TPT coverage), suboptimal health cadre effectiveness, and resource constraints. Reinforcing factors encompassed inconsistent treatment supervision, limited multi-stakeholder involvement, notably absent educational institution engagement, and programme evaluation gaps. Critically, these barriers interacted across domains through cascading mechanisms, with stigma amplifying system weaknesses and undermining supervision. Conclusion TB control in rural Indonesia faces interconnected barriers across all three PRECEDE-PROCEED domains. Young people and schools are underutilised resources with strong potential as agents of change, justifying the development of community-based youth empowerment interventions.