Defining tuberculosis stigma: a protocol for a systematic review, analysis, and thematic synthesis

Abstract

Background Throughout recorded history, tuberculosis is believed to have killed more people than any other infectious disease. Despite the World Health Organization’s determination that preventing and controlling tuberculosis will require understanding and reducing tuberculosis stigma, we noted strikingly diverse definitions and lack of consensus in describing tuberculosis stigma. Furthermore, we found no systematic reviews in the existing tuberculosis stigma literature characterizing, comparing, or assessing tuberculosis stigma definitions or their consistency. To address this knowledge gap, we intend to conduct a systematic review of existing tuberculosis stigma definitions used in the academic research literature, and through quantitative synthesis of the words and phrases contained within those definitions, identify themes that characterize tuberculosis stigma. Methods Studies containing definitions of tuberculosis stigma will be identified by searching two electronic databases -- PubMed and PsycINFO – using the Medical Subject Heading (MeSH) terms “stigma[MeSH Major Topic] AND tuberculosis[MeSH Major Topic]”. Study inclusion criteria will consist of: a) original research published in English, (due to logistical constraints); b) qualitative studies using semi-structured interviews and focus group discussions; c) quantitative studies including descriptive studies and trials, questionnaires, and cross-sectional surveys; and d) mixed method studies. Included studies will be searched for definitions of tuberculosis stigma using the search term “defin”. Descriptive words and phrases will be extracted from definitions and categorized into themes, based on noun, verb, adjective, and adverb derivatives; and synonym definitions. Predominant themes will then be identified and further categorized as emotion, thought, or behaviour themes. Relative frequencies of definitions, and definition words and phrases, will be compared quantitively. Conclusions This systematic review and thematic analysis is intended to characterize academic definitions of tuberculosis stigma and identify predominant tuberculosis stigma themes contained within those definitions. Registration PROSPERO (CRD42023440978; 23 July 2023).