Situating Standards in Practices

Multi Drug-Resistant Tuberculosis Treatment in India

Datos Bibliográficos

ID12205773
AutoresNora Engel (0000-0002-1823-3908, Maastricht University, autor de correspondencia), Ragna Zeiss (Maastricht University)
Año2013
Volumen23
Número2
Páginas201-225
Fecha de publicación2013-10-02
Peer ReviewedSí
Open AccessNo
TipoARTICLE
RevistaScience as Culture (JOURNAL)
Identificadores de la revistaISSN: 0950-5431 • E-ISSN: 1470-1189
EditorialTaylor & Francis (PUBLISHER • GB)
DOI10.1080/09505431.2013.837875
OpenAlexW1964222462
IdiomaEN
Citas recibidas2
Referencias citadas28

Public health care needs to cope with a basic dilemma between providing standardized care within public programmes across entire and at times resource-constrained countries and adapting this care locally when responding to individual needs. This tension between standardization and local adaptation becomes particularly obvious for the prolonged and complicated treatment of multidrug-resistant tuberculosis (MDR-TB). Situated standardization, as introduced by Zuiderent-Jerak [2007a, 2007b] offers a way out of this dilemma. It helps to focus on how standards need to be situated in practice rather than viewing standardization and local adaptation as mutually exclusive practices. How do actors relate standardization and individual care in their practices of treating MDR-TB? Results from qualitative fieldwork at the first MDR-TB treatment sites of the Indian TB programme show that actors situate standards in a particular way. They assess the role of guidelines in a particular situation and on that basis recognize the core recommendations of guidelines or go beyond the guidelines. This allows actors to negotiate how standards should be situated and reconciles the dilemma between local adaptation and standardization. Having guidelines internalized, as is common for Indian TB control, bears both promises and pitfalls for engaging in standardization processes in a situated manner. The results contribute to science and technology study scholarship on guideline development. They highlight how actors coordinate the situating of standards and how this depends upon cultures of control. This illustrates the potential of qualitative studies on local adaptation for guideline developers by revealing existing practices of relating and negotiating local adaptation and standardization

Dilemma · Guideline · Negotiation · Political science · Public relations · Qualitative research · Situated · Social science · Sociology · Standardization · Computer Science · Health Policy Implementation Science · Health Systems, Economic Evaluations, Quality of Life · Medicine · Mental Health and Patient Involvement