The architecture of adherence
A gender–relational analysis of men's tuberculosis treatment journeys in Eastern Cape, South Africa
Bibliographic Data
| ID | 24243418 |
|---|---|
| Authors | Raheleh Bahrami (0000-0001-7001-8140), Andrew Medina-Marino (0000-0002-0095-4141), Nondumiso Ngcelwane, Singilizwe Moko, Gloria Maimela (0000-0002-7704-6803), Sarita Naidoo (0000-0001-5067-1601), Sarah Sarandos, Joseph A Daniels |
| Year | 2026 |
| Volume | 10 |
| Pages | 100890 |
| Publication date | 2026-12-01 |
| Open Access | Yes |
| Type | ARTICLE |
| Venue | SSM - Qualitative Research in Health (JOURNAL) |
| Journal identifiers | ISSN: 2667-3215 • E-ISSN: 2667-3215 |
| Publisher | Elsevier BV (PUBLISHER) |
| DOI | 10.1016/j.ssmqr.2026.100890 |
| OpenAlex | W7224571570 |
| Language | EN |
| References cited | 43 |
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.
Gender Roles and Identity Studies · HIV/AIDS Research and Interventions · Tuberculosis Research and Epidemiology
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| Highly cited | No |
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