“The way I am being treated matters more to me than the TB itself”: experiences of stigma in healthcare settings among people with drug-resistant tuberculosis in Lagos, Nigeria: a qualitative study
Year: 2026
Type: article
Abstract: Background Healthcare-associated stigma remains a critical but underexplored barrier to effective drug-resistant tuberculosis (DR-TB) care, particularly in high-burden settings. Negative attitudes and discriminatory behaviours by healthcare workers (HCWs) may undermine treatment adherence, psychological well-being, and trust in the health system among people with DR-TB (PwDR-TB). This study explored the lived experiences of healthcare-related stigma among PwDR-TB in Lagos, Nigeria, and examined its implications for care engagement and treatment outcomes. Methods Five focus group discussions were held with 53 PwDR-TB receiving care at five purposively selected DR-TB outpatient treatment centres in Lagos between April and June 2024. Participants were adults aged 18 years or older who had been on treatment for at least 3 months. Discussions were audio-recorded, transcribed verbatim, and analysed using thematic analysis. Reporting was guided by the Consolidated Criteria for Reporting Qualitative Research (COREQ). Link and Phelan’s stigma framework informed the interpretation of the findings. Results Three major themes emerged. First, participants described pervasive stigmatising attitudes and behaviours from HCWs, including rudeness, avoidance, and public humiliation during care encounters. Second, these experiences produced profound emotional and behavioural consequences, including feelings of shame, dehumanisation, reduced trust in healthcare providers, and reluctance to attend clinic appointments, with some participants contemplating treatment interruption. Third, HCWs inadvertently reinforced stigma through fear-based infection prevention counselling, which promoted unnecessary isolation practices at home and contributed to social exclusion and psychological distress. Participants perceived stigma within healthcare settings as more severe than in the community due to the inability to conceal their diagnosis and the authority of HCWs. Using Link and Phelan’s framework, these findings reflect processes of labelling, stereotyping, separation, and discrimination operating within healthcare environments. Conclusion Healthcare-associated stigma represents a significant barrier to patient-centred DR-TB care in Nigeria. Interventions are needed at multiple levels, including HCW training on respectful communication and evidence-based infection control, psychosocial support for patients, and institutional mechanisms for reporting discrimination. Addressing stigma across its structural and interpersonal dimensions may improve treatment adherence, patient experiences, and overall DR-TB outcomes in high-burden settings.
Source: BMC Public Health
Institutions: Durban University of Technology, Olabisi Onabanjo University
Language: English
Subfield: Infectious Diseases
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,290
OpenAlex ID: W7160599633