Perspectives of primary health care providers on migrant patients’ adherence to TB treatment

Tuberculosis (TB) is considered a global health problem. TB incidence has been increasing in Portugal among the foreign born population. International migration has been posing challenges to European health systems in their effort to provide accessible, equitable and quality care to diverse populations. Research has been approaching the perspectives of health care providers on the provision of care to migrant populations. In addition, qualitative approach has been increasingly used in health research to better understand the complex and interrelated influence of multiple factors at individual, social and contextual levels on health issues, like health care provision. This study aimed to explore health care providers’ perspectives about migrant patients’ adherence to TB treatment and related factors, and debate on the value of using a qualitative research approach in a health topic traditionally researched through quantitative methods. The study was conducted through individual semi-structured interviews with 17 health care providers (doctors and nurses) working in primary care settings related to prevention, treatment and diagnosis of tuberculosis in Lisbon Region, Portugal. Snowball sampling was used to recruit participants. Each interview took about 40 minutes, and was audio recorded. The interview guide covered 2 main topics: adherence to TB treatment among migrant patients; barriers and facilitating factors of migrants’ TB-treatment adherence. Sampling of participants was performed in parallel with data collection, and was concluded when saturation of responses was reached. Data were analyzed using a thematic analysis approach. This qualitative approach allowed us to gain a clearer insight into the migrants’ adherence to TB treatment and related factors as expressed by health care providers. The use of a qualitative approach in this study had several advantages. One added value of using a qualitative approach was that the context of data collection – individual interviews – was conducive to the open expression of personal opinions, enabling researchers to access participants’ perspectives and understand how each one constructs and interprets his/her own reality and experience concerning their migrant patients’ adherence to TB treatment. The researcher-interviewee interaction lead participants to feel comfortable and share their perspectives, which may help remove potential defensive attitudes towards talking about topics frequently associated with “political correctness” and ethical professional principles such as attitudes regarding care provision to migrant patients. Globally, the use of a qualitative approach in this study contributed to produce rich, relevant and useful knowledge that may be helpful to inform health policies and good practices for the promotion of TB-treatment adherence among a most vulnerable population like migrants.