Work

The architecture of adherence: A gender–relational analysis of men's tuberculosis treatment journeys in Eastern Cape, South Africa

Year: 2026

Type: article

Abstract: ABSTRACT Background Men experience disproportionate delays in tuberculosis (TB) diagnosis and challenges in adherence to treatment in part due to gender norms and social perceptions that illness and help-seeking by men are forms of weakness and vulnerability. This study explored how men with TB navigate treatment adherence within a gender-relational context, with particular attention to how masculinity is negotiated through caregiving relationships. Methods A secondary qualitative analysis was conducted using de-identified, semi-structured interviews with 30 men who were undergoing or had recently completed TB treatment in Eastern Cape, South Africa. Guided by Courtenay's Theory of Gender and Health, a reflexive thematic analysis was conducted. Analysis proceeded through iterative phases of familiarization, codebook development, theory-informed categorization, thematic development and refinement, and conceptual synthesis. Results Four interrelated themes were identified: Managing Illness Visibility and Masculine Self-Presentation ; Negotiating Help-Seeking Through Trusted Relationships ; Relational Support for Sustaining Treatment Engagement ; and R esponsibility, Protection, and the Moral Logic of Adherence . Themes were organized into a theory-informed gender–relational process illustrating how masculinity may be negotiated in the context of illness, using TB as the empirical setting. Conclusion Men's TB treatment adherence may be best understood as a gender-relational process, embedded within a social and caregiving context. Recognizing relational conditions (i.e., women's caregiving contributions) that support men's engagement in care may inform more gender-responsive and relationally attuned approaches to supporting men when they are ill.

Source: SSM - Qualitative Research in Health

DOI: 10.1016/j.ssmqr.2026.100890