Repository of Practices
Primary GCM Objectives
Secondary GCM Objectives
11
12
15
GCM Guiding Principles*
Sustainable Development Goals (SDGs)
Dates
2020 - 2022
Summary
The gender-focused qualitative study on healthcare-seeking behavior and access to tuberculosis treatment among migrants from the Republic of Moldova was conducted within the project “Enhancing Gender-Sensitive Tuberculosis Detection, Surveillance, Treatment, and Prevention among Mobile Populations from the Republic of Moldova” funded by the IOM Development Fund. The study aimed to determine the differences between men and women in the knowledge, attitudes, and practices regarding the diagnosis, surveillance, treatment, and prevention of tuberculosis (TB) among mobile populations in the Republic of Moldova to formulate recommendations for improving tuberculosis prevention, treatment and care among migrants.
Research objectives:
- To assess the knowledge, attitudes, and practices regarding access to health care among the mobile population affected by tuberculosis, from a gender perspective.
- To describe the perception of the specialists on the migration phenomena and its influence on the access of the mobile population to TB health services.
- To identify the barriers to access and continuity of medical care for the mobile population affected by tuberculosis.
Study Population and method;
The sample included 100 TB patients with migration history and 30 healthcare specialists. In particular, the sample for semi-structured interviews consisted of 50 TB patients (25 men and 25 women) and 15 healthcare specialists. For focus group discussions (FGDs), the sample consisted of 50 TB patients (6 FGDs) and 15 healthcare specialists (2 FGDs). The interviews were transcribed, and data was analyzed using the method of thematic frame and by comparing the collected data based on gender, country of destination, type of TB, and where the treatment was started. The main analysis themes were already identified during the development of the interview guides, while others were derived from the collected data. The analysis envisaged discovering trends and recurrent patterns, but also highlighting divergent views from the different respondents, including gender perspectives.
Organizations
Main Implementing Organization(s)
International Organization for Migration (IOM)
Partner/Donor Organizations
Government of Moldova
Benefit and Impact
The study identified key results regarding the health-care seeking behaviour of Moldovan migrant men and women for tuberculosis testing and treatment. These will inform the implementation of the National Tuberculosis Programme for 2021–2025, and the development of projects to support on enhancing TB prevention and diagnosis, treatment adherence, as well as the management of post-treatment situations. Although migrants are included as key population in the National Tuberculosis Programme, it is still necessary to scale up programs for free TB screening for migrants and to provide more resources for long-term outpatient treatment.
Moldovan tuberculosis patients with migration experience are mostly men of working age, as the majority of migrants are men. The results showed that most interviewed migrants with TB, regardless of gender, had limited knowledge of TB before diagnosis. Men were more likely to seek medical care later than women and were more vulnerable to discontinuing TB treatment. Health workers and patients highlighted negative perceptions of tuberculosis, including stigma, and the lack of basic knowledge about the disease. A higher psycho-emotional vulnerability was characteristic of migrant women with tuberculosis, due to their concern for the safety of family members. Among migrant men, socioeconomic factors with the need to earn money abroad contributed to an increased risk of TB abandoning treatment. External migration was clearly identified as a risk factor for infection with TB, and TB recurrence among the respondents was determined by the living conditions and working environment, including aspects like poor nutrition, stress, and over-exhaustion.
While ten years ago most Moldovan migrants diagnosed with TB had returned from the Russian Federation, the destination countries diversified, including Poland and the Czech Republic as destinations for seasonal work. Many interviewees were diagnosed with TB in the Republic of Moldova. Other had returned with a TB diagnosis from the Russian Federation and Romania – countries where Moldovans face no language barrier.
Moldovan tuberculosis patients with migration experience are mostly men of working age, as the majority of migrants are men. The results showed that most interviewed migrants with TB, regardless of gender, had limited knowledge of TB before diagnosis. Men were more likely to seek medical care later than women and were more vulnerable to discontinuing TB treatment. Health workers and patients highlighted negative perceptions of tuberculosis, including stigma, and the lack of basic knowledge about the disease. A higher psycho-emotional vulnerability was characteristic of migrant women with tuberculosis, due to their concern for the safety of family members. Among migrant men, socioeconomic factors with the need to earn money abroad contributed to an increased risk of TB abandoning treatment. External migration was clearly identified as a risk factor for infection with TB, and TB recurrence among the respondents was determined by the living conditions and working environment, including aspects like poor nutrition, stress, and over-exhaustion.
While ten years ago most Moldovan migrants diagnosed with TB had returned from the Russian Federation, the destination countries diversified, including Poland and the Czech Republic as destinations for seasonal work. Many interviewees were diagnosed with TB in the Republic of Moldova. Other had returned with a TB diagnosis from the Russian Federation and Romania – countries where Moldovans face no language barrier.
Key Lessons
The study design is qualitative and hence even though the sample was rather large it allows only for the description of phenomena and related trends in society without allowing for the generalization of expression in percentages. A certain selection bias and the setting in which interviews were conducted, might have influenced the findings. The study only included TB patients and is limited to those who were diagnosed and undergoing treatment. Patients were recruited through medical workers.
Although participation in the study was voluntary, a safe and friendly environment was ensured during the discussions, and anonymity and confidentiality were granted, the reluctance of some of the participants was noted to express their opinion on this topic. The specialists were also recruited through representatives of the medical institutions, which also might have impeded them from expressing some opinions openly. Migrants who were treated for TB abroad and were not in the country during the study were not included in the study sample, due to which the subject was addressed only in interviews with the specialists. Also, the patients who dropped out of the treatment and were not in the country during the study were not interviewed.
The data presented in this study uses the binary sex categories of male and female. The migration of people with diverse gender identities and/or expressions, and that of those who are intersex, has not to date been explicitly captured in migration data. IOM looks forward to sharing more comprehensive and inclusive migration data in the future.
Although participation in the study was voluntary, a safe and friendly environment was ensured during the discussions, and anonymity and confidentiality were granted, the reluctance of some of the participants was noted to express their opinion on this topic. The specialists were also recruited through representatives of the medical institutions, which also might have impeded them from expressing some opinions openly. Migrants who were treated for TB abroad and were not in the country during the study were not included in the study sample, due to which the subject was addressed only in interviews with the specialists. Also, the patients who dropped out of the treatment and were not in the country during the study were not interviewed.
The data presented in this study uses the binary sex categories of male and female. The migration of people with diverse gender identities and/or expressions, and that of those who are intersex, has not to date been explicitly captured in migration data. IOM looks forward to sharing more comprehensive and inclusive migration data in the future.
Recommendations(if the practice is to be replicated)
- Determine what you aim to achieve with your study, such as identifying risk factors, assessing the effectiveness of interventions, or informing policy.
- Familiarize yourself with the socio-economic, cultural, and legal contexts that influence TB.
- Ensure participants understand the study and give informed consent, especially considering language barriers and cultural differences.
- Protect participants' identities and sensitive information, particularly given the vulnerabilities of migrant populations.
- Include migrants in the planning and implementation phases to ensure the study is culturally sensitive and relevant.
- Based on your findings, provide actionable recommendations to improve TB prevention, diagnosis, and treatment among migrants.
- Utilize resources from academic institutions, NGOs, and health organizations to support your research.
- Assess the impact of your findings on policy and practice and seek ways to maximize the benefits of the research.
- Familiarize yourself with the socio-economic, cultural, and legal contexts that influence TB.
- Ensure participants understand the study and give informed consent, especially considering language barriers and cultural differences.
- Protect participants' identities and sensitive information, particularly given the vulnerabilities of migrant populations.
- Include migrants in the planning and implementation phases to ensure the study is culturally sensitive and relevant.
- Based on your findings, provide actionable recommendations to improve TB prevention, diagnosis, and treatment among migrants.
- Utilize resources from academic institutions, NGOs, and health organizations to support your research.
- Assess the impact of your findings on policy and practice and seek ways to maximize the benefits of the research.
Innovation
This research was pioneering in the Republic of Moldova, as it was the first study to explore healthcare-seeking behavior regarding tuberculosis among migrants from a gender-sensitive perspective. This novel approach addresses both the unique challenges faced by migrants and the specific needs of men and women, thereby offering a more comprehensive understanding of TB healthcare access.
By focusing on gender, the study highlighted the differing experiences and barriers faced by men and women in accessing TB care. This gender-sensitive approach ensures that health interventions can be tailored to meet gender-specific needs, who might otherwise be overlooked in standard health programs.
The inclusion of migrant communities in the research process was another innovative aspect. By actively involving these communities, the study ensured that their voices and experiences shaped the design and implementation of the research. This participatory approach not only enriched the data collected but also fostered trust and relevance among the migrant population.
The most tangible and immediate impact of the project was the development and endorsement of the National TB Program for 2021-2025. This program incorporated the project's activities and mainstreamed gender and migrant-sensitive TB interventions. This integration into national policy signifies a major step forward in addressing TB among migrants, highlighting the study's influence on health policy and its potential to drive systematic change.
These innovative aspects demonstrate how the study not only advanced academic understanding but also had practical implications for health policy and community empowerment in Moldova.
By focusing on gender, the study highlighted the differing experiences and barriers faced by men and women in accessing TB care. This gender-sensitive approach ensures that health interventions can be tailored to meet gender-specific needs, who might otherwise be overlooked in standard health programs.
The inclusion of migrant communities in the research process was another innovative aspect. By actively involving these communities, the study ensured that their voices and experiences shaped the design and implementation of the research. This participatory approach not only enriched the data collected but also fostered trust and relevance among the migrant population.
The most tangible and immediate impact of the project was the development and endorsement of the National TB Program for 2021-2025. This program incorporated the project's activities and mainstreamed gender and migrant-sensitive TB interventions. This integration into national policy signifies a major step forward in addressing TB among migrants, highlighting the study's influence on health policy and its potential to drive systematic change.
These innovative aspects demonstrate how the study not only advanced academic understanding but also had practical implications for health policy and community empowerment in Moldova.
Additional Resources
Date submitted:
28 July 2024
*References to Kosovo shall be understood to be in the context of United Nations Security Council resolution 1244 (1999).