The architecture of adherence: A gender–relational analysis of men's tuberculosis treatment journeys in Eastern Cape, South Africa
5 affiliations
- 1Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, United States; Corresponding author. Edson College of Nursing and Health Innovation, Arizona State University, 550 N 3rd St. Phoenix, AZ, 85004, United States.
- 2Buffalo City Metro Health District, Eastern Cape Provincial Department of Health, East London, South Africa
- 3Epidemiology and Research Directorate, Eastern Cape Provincial Department of Health, Bisho, South Africa; Department of Public Health, Faculty of Medicine and Health Sciences, Walter Sisulu University, South Africa
- 4Foundation for Professional Development, Pretoria, South Africa
- 5Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, United States
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.
Related
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BibTeX
@article{bahrami2026architecture,
title = {{The architecture of adherence: A gender–relational analysis of men's tuberculosis treatment journeys in Eastern Cape, South Africa}},
author = {Raheleh Bahrami and Andrew Medina-Marino and Nondumiso Ngcelwane and Singilizwe Moko and Gloria Maimela and Sarita Naidoo and Sarah Sarandos and Joseph A. Daniels},
journal = {SSM: Qualitative Research in Health},
year = {2026},
month = oct,
doi = {10.1016/j.ssmqr.2026.100890},
url = {https://doi.org/10.1016/j.ssmqr.2026.100890},
note = {CC BY},
}
RIS
TY - JOUR
TI - The architecture of adherence: A gender–relational analysis of men's tuberculosis treatment journeys in Eastern Cape, South Africa
AU - Raheleh Bahrami
AU - Andrew Medina-Marino
AU - Nondumiso Ngcelwane
AU - Singilizwe Moko
AU - Gloria Maimela
AU - Sarita Naidoo
AU - Sarah Sarandos
AU - Joseph A. Daniels
PY - 2026
DA - 2026/10/31
JO - SSM: Qualitative Research in Health
DO - 10.1016/j.ssmqr.2026.100890
UR - https://doi.org/10.1016/j.ssmqr.2026.100890
AB - 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.
SN - 2667-3215
ER -