{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T05:17:35Z","timestamp":1788931055059,"version":"build-2803163510"},"reference-count":42,"publisher":"MDPI AG","issue":"20","license":[{"start":{"date-parts":[[2022,10,20]],"date-time":"2022-10-20T00:00:00Z","timestamp":1666224000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Background: Tuberculosis remains the number one killer among infectious diseases in South Africa. The TB disease burden is said to be higher among males, 1.6 times more than females in 2018. Moreover, men are reported to have poor healthcare-seeking behaviors. Loss in social and physical functioning, including reduced sexual desires and changes in family life, have been reported following a TB diagnosis. This study explored the meaning that male TB patients attach to their TB diagnosis and impact of TB infection in their lives and those of the people living with them. Methods: This exploratory qualitative study was conducted among 25 participants recruited among male patients seeking TB care from two clinics in informal settlements of the city of Johannesburg. In-depth interviews with open-ended questions were conducted using an audio recorder for the collection of data. Data analysis was conducted on the NVivo version 12 software following an inductive thematic approach. Results: The ages of the participants ranged between 18 and 61 years. Most were unemployed, and only a few were married or in steady relationships. From the two emerging themes, pre-TB diagnosis health-seeking behaviors and post TB-diagnosis experiences, several subthemes were identified. For the former theme, the subthemes include, seeking help from community-based healers and self-medicating, waiting for some period to see if the alternative medicine or treatment worked, taking time to visit a healthcare facility, triggers to seek healthcare, and symptoms reported on presentation to the healthcare facility. The post-TB diagnosis subthemes include making sense of the TB diagnosis, context of disclosing the TB status, fear of social exclusion and experiences of stigma, support received during illness, life changes after TB infection and diagnosis, and lessons learned from the TB experience and future healthcare-seeking behavior. Conclusion: Secrecy about the TB diagnosis indicates fear of social exclusion, and this could be due to the highly stigmatized nature of TB. Waiting to see if alternative medication worked, delayed the TB diagnosis, with consequent late initiation of the anti-TB treatment. The life changes experienced post-TB diagnosis affect the quality of life of the participants and their families. The study recommends that these issues be addressed as a priority.<\/jats:p>","DOI":"10.3390\/ijerph192013635","type":"journal-article","created":{"date-parts":[[2022,10,20]],"date-time":"2022-10-20T22:49:46Z","timestamp":1666306186000},"page":"13635","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Pre-Diagnosis Health Seeking Behaviors and Experiences Post-Diagnosis, among Men Diagnosed with Tuberculosis in a District of Gauteng Metropolitan City, South Africa: In-Depth Interviews"],"prefix":"10.3390","volume":"19","author":[{"given":"Sewele","family":"Makgopa","sequence":"first","affiliation":[{"name":"Department of Public Health, Sefako Makgatho Health Sciences University, Molotlegi Street, Pretoria 0208, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lindiwe P.","family":"Cele","sequence":"additional","affiliation":[{"name":"Department of Public Health, Sefako Makgatho Health Sciences University, Molotlegi Street, Pretoria 0208, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5807-8212","authenticated-orcid":false,"given":"Mathildah M.","family":"Mokgatle","sequence":"additional","affiliation":[{"name":"Department of Public Health, Sefako Makgatho Health Sciences University, Molotlegi Street, Pretoria 0208, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,10,20]]},"reference":[{"key":"ref_1","unstructured":"WHO (2022, March 05). Tuberculosis. Available online: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/tuberculosis."},{"key":"ref_2","unstructured":"SAMRC (2022, March 05). The First National TB Prevalence Survey-South Africa. Available online: https:\/\/www.knowledgehub.org.za\/system\/files\/elibdownloads\/2021-02\/A4_SA_TPS%20Short%20Report_10June20_Final_highres.pdf."},{"key":"ref_3","unstructured":"STATSSA (2022, March 05). TB Tops Leading Causes of Death in SA in 2018, Available online: https:\/\/www.statssa.gov.za\/publications\/P03093\/P030932018.pdf."},{"key":"ref_4","unstructured":"WHO (2022, March 06). Tuberculosis. Available online: https:\/\/www.hst.org.za\/publications\/NonHST%20Publications\/Global%20TB%20Report%202019.pdf."},{"key":"ref_5","unstructured":"WHO (2022, October 05). Tuberculosis Profile: South Africa. Available online: https:\/\/worldhealthorg.shinyapps.io\/tb_profiles\/?_inputs_&entity_type=%22country%22&lan=%22EN%22&iso2=%22ZA%22."},{"key":"ref_6","unstructured":"(2022, March 06). National TB Management Guidelines. Available online: https:\/\/www.tbonline.info\/media\/uploads\/documents\/national_tuberculosis_management_guidelines_%282014%29.pdf."},{"key":"ref_7","unstructured":"World Bank (2022, October 05). South Africa Overview: Development News, Research, Data. Available online: https:\/\/www.worldbank.org\/en\/country\/southafrica\/overview."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Nidoi, J., Muttamba, W., Walusimbi, S., Imoko, J.F., Lochoro, P., Ictho, J., Mugenyi, L., Sekibira, R., Turyahabwe, S., and Byaruhanga, R. (2021). Impact of socio-economic factors on Tuberculosis treatment outcomes in north-eastern Uganda: A mixed methods study. BMC Public Health, 21.","DOI":"10.1186\/s12889-021-12056-1"},{"key":"ref_9","unstructured":"World Bank (2022, March 07). Unmemployment\u2014South Africa. Available online: https:\/\/data.worldbank.org\/indicator\/SL.UEM.TOTL.ZS?locations=ZA."},{"key":"ref_10","unstructured":"Stats SA (2022, October 06). South Africa\u2019s Youth Continues to Bear the Burden of Unemployment, Available online: https:\/\/www.statssa.gov.za\/?p=15407."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Nkosi, V., Haman, T., Naicker, N., and Mathee, A. (2019). Overcrowding and health in two impoverished suburbs of Johannesburg, South Africa. BMC Public Health, 19.","DOI":"10.1186\/s12889-019-7665-5"},{"key":"ref_12","unstructured":"MSF (2022, March 09). South Africa, Five Deadly Barriers for Effective TB Care. Available online: https:\/\/reliefweb.int\/report\/south-africa\/five-deadly-barriers-effective-tb-care."},{"key":"ref_13","unstructured":"Smith, J. (2022, March 09). Men Seen as Main Source of TB Transmission. Available online: https:\/\/www.mdedge.com\/chestphysician\/article\/105333\/international-id\/men-seen-main-source-tb-transmission#:~:text=Prevalence%20of%20TB%20was%20markedly,care%2C%20and%20access%20to%20care."},{"key":"ref_14","first-page":"1682111","article-title":"Masculinity and men\u2019s health-seeking behaviour in Nigerian academia","volume":"5","author":"Olanrewaju","year":"2019","journal-title":"Cogent Soc. Sci."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"616","DOI":"10.1111\/j.1365-2648.2004.03331.x","article-title":"Men and health help-seeking behaviour: Literature review","volume":"49","author":"Galdas","year":"2005","journal-title":"J. Adv. Nurs."},{"key":"ref_16","unstructured":"Dawson, H., Lomahoza, K., and Monnana, T. (2013). The Right to Social Security and Primary Health Care in Zandspruit Informal Settlement South Africa, SPII."},{"key":"ref_17","unstructured":"Mahajan, S. (2022, March 09). Economics of South African Townships: Special Focus on Diepsloot. Available online: https:\/\/documents1.worldbank.org\/curated\/ar\/217211468302413395\/pdf\/Economics-of-South-African-townships-special-focus-on-Diepsloot.pdf."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1845","DOI":"10.1016\/j.socscimed.2004.08.024","article-title":"Perceptions of tuberculosis patients about their physical, mental and social well-being: A field report from south India","volume":"60","author":"Rajeswari","year":"2005","journal-title":"Soc. Sci. Med."},{"key":"ref_19","first-page":"162","article-title":"Psychosocial trauma of diagnosis: A qualitative study on rural TB patients\u2019 experiences in Nalgonda district, Andhra Pradesh","volume":"60","author":"Venkatraju","year":"2013","journal-title":"Indian J. Tuberc."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1016\/j.puhe.2016.12.017","article-title":"A disease called stigma: The experience of stigma among African men with TB diagnosis in London","volume":"145","author":"Chinouya","year":"2017","journal-title":"Public Health"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"280","DOI":"10.5588\/ijtld.17.0539","article-title":"Delay in seeking care for tuberculosis symptoms among adults newly diagnosed with HIV in rural Malawi","volume":"22","author":"Ngwira","year":"2018","journal-title":"Int. J. Tuberc. Lung Dis."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1071","DOI":"10.4269\/ajtmh.16-0892","article-title":"Patients\u2019 delay in seeking health care for tuberculosis diagnosis in East Gojjam zone, Northwest Ethiopia","volume":"96","author":"Asres","year":"2017","journal-title":"Am. J. Trop. Med. Hyg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"27","DOI":"10.11604\/pamj.2021.39.27.26717","article-title":"Prevalence of delay in seeking tuberculosis care and the health care seeking behaviour profile of tuberculous patients in a rural district of KwaZulu Natal, South Africa","volume":"39","author":"Chiposi","year":"2021","journal-title":"Pan Afr. Med. J."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Ayisi, J.G., van\u2019t Hoog, A.H., Agaya, J.A., Mchembere, W., Nyamthimba, P.O., Muhenje, O., and Marston, B.J. (2011). Care seeking and attitudes towards treatment compliance by newly enrolled tuberculosis patients in the district treatment programme in rural western Kenya: A qualitative study. BMC Public Health, 11.","DOI":"10.1186\/1471-2458-11-515"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"6","DOI":"10.11604\/pamj.supp.2014.18.1.4166","article-title":"Knowledge, care-seeking behavior, and factors associated with patient delay among newly-diagnosed pulmonary tuberculosis patients, Federal Capital Territory, Nigeria, 2010","volume":"18","author":"Biya","year":"2014","journal-title":"Pan Afr. Med. J."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Naidoo, P., Van Niekerk, M., Du Toit, E., Beyers, N., and Leon, N. (2015). Pathways to multidrug-resistant tuberculosis diagnosis and treatment initiation: A qualitative comparison of patients\u2019 experiences in the era of rapid molecular diagnostic tests. BMC Health Serv. Res., 15.","DOI":"10.1186\/s12913-015-1145-0"},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Engelbrecht, M., Rau, A., Kigozi, G., Janse van Rensburg, A., Wouters, E., Sommerland, N., Masquillier, C., and Uebel, K. (2019). Waiting to inhale: Factors associated with healthcare workers\u2019 fears of occupationally-acquired tuberculosis (TB). BMC Infect. Dis., 19.","DOI":"10.1186\/s12879-019-4115-z"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"e000121","DOI":"10.1136\/fmch-2019-000121","article-title":"Care and social support from family and community in patients with pulmonary tuberculosis in Pakistan","volume":"7","author":"Saqib","year":"2019","journal-title":"Fam. Med. Community Health"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"105","DOI":"10.4103\/ejb.ejb_15_18","article-title":"Erectile dysfunction in pulmonary tuberculosis: Is it a common association?","volume":"13","author":"Magdy","year":"2019","journal-title":"Egypt. J. Bronchol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1186\/s40248-018-0121-z","article-title":"Examining the social status, risk factors and lifestyle changes of tuberculosis patients in Sri Lanka during the treatment period: A cross-sectional study","volume":"13","author":"Senanayake","year":"2018","journal-title":"Multidiscip. Respir. Med."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Cremers, A.L., de Laat, M.M., Kapata, N., Gerrets, R., Klipstein-Grobusch, K., and Grobusch, M.P. (2015). Assessing the consequences of stigma for tuberculosis patients in urban Zambia. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0119861"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1177\/00333549101250S407","article-title":"Tuberculosis and stigmatization: Pathways and interventions","volume":"125","author":"Courtwright","year":"2010","journal-title":"Public Health Rep."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1961","DOI":"10.1111\/j.1365-2702.2010.03516.x","article-title":"A qualitative review: The stigma of tuberculosis","volume":"20","author":"Juniarti","year":"2011","journal-title":"J. Clin. Nurs."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"727","DOI":"10.29024\/aogh.2383","article-title":"Exploring manifestations of TB-related stigma experienced by women in Kolkata, India","volume":"84","author":"Mukerji","year":"2018","journal-title":"Ann. Glob. Health"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"102","DOI":"10.4103\/jgid.jgid_136_18","article-title":"Assessment of health-related quality of life among tuberculosis patients in a public primary care facility in Indonesia","volume":"11","author":"Sartika","year":"2019","journal-title":"J. Glob. Infect. Dis."},{"key":"ref_36","first-page":"101","article-title":"Tuberculosis as a reason for male and female sexual dysfunction","volume":"1","author":"Kulchavenya","year":"2017","journal-title":"Ann. Infect. Antibiot."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1186\/s12978-017-0341-2","article-title":"Male reproductive health challenges: Appraisal of wives coping strategies","volume":"14","author":"Amoo","year":"2017","journal-title":"Reprod. Health"},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Chen, X., Du, L., Wu, R., Xu, J., Ji, H., Zhang, Y., Zhu, X., and Zhou, L. (2020). The effects of family, society and national policy support on treatment adherence among newly diagnosed tuberculosis patients: A cross-sectional study. BMC Infect. Dis., 20.","DOI":"10.1186\/s12879-020-05354-3"},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Munro, S.A., Lewin, S.A., Smith, H.J., Engel, M.E., Fretheim, A., and Volmink, J. (2007). Patient adherence to tuberculosis treatment: A systematic review of qualitative research. PLoS Med., 4.","DOI":"10.1371\/journal.pmed.0040238"},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Tedla, K., Medhin, G., Berhe, G., Mulugeta, A., and Berhe, N. (2020). Delay in treatment initiation and its association with clinical severity and infectiousness among new adult pulmonary tuberculosis patients in Tigray, northern Ethiopia. BMC Infect. Dis., 20.","DOI":"10.1186\/s12879-020-05191-4"},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Cheng, S., Chen, W., Yang, Y., Chu, P., Liu, X., Zhao, M., Tan, W., Xu, L., Wu, Q., and Guan, H. (2013). Effect of diagnostic and treatment delay on the risk of tuberculosis transmission in Shenzhen, China: An observational cohort study, 1993\u20132010. PLoS ONE, 8.","DOI":"10.1371\/journal.pone.0067516"},{"key":"ref_42","unstructured":"(2022, October 07). WHO Guidelines on Tuberculosis Infection Prevention and Control, 2019 Update, Available online: https:\/\/apps.who.int\/iris\/bitstream\/handle\/10665\/311259\/9789241550512-eng.pdf."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/20\/13635\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T00:58:29Z","timestamp":1760144309000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/20\/13635"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,10,20]]},"references-count":42,"journal-issue":{"issue":"20","published-online":{"date-parts":[[2022,10]]}},"alternative-id":["ijerph192013635"],"URL":"https:\/\/doi.org\/10.3390\/ijerph192013635","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,10,20]]}}}