Barrier and facilitator for chest X-ray tuberculosis-diabetes mellitus (CXR TB-DM) programme from patient’s perspective: a qualitative study

Indonesia responded to the Collaborative Framework for the Care and Control of Tuberculosis and Diabetes (CF TB-DM) in 2015. Specific details of the Standard Operating Procedure (SOP) were released in 2021, including the use of chest X-ray (CXR) for TB screening among people with diabetes (PWD). Little is known about how people with diabetes perceive CXR-based TB screening implemented under Indonesia’s national TB-DM collaborative programme. This study explores barriers and facilitators to the programme from patients’ perspectives in Semarang City and Klaten District, Indonesia. This qualitative descriptive study utilised three focus group discussions ( n = 18) and two in-depth interviews ( n = 2) conducted in Central Java, Indonesia, between August and November 2023. The sample was selected using purposive sampling from both hospital and non-hospital settings. Semi-structured interview guides with open-ended questions were used for the IDIs and FGDs. Descriptive quotes were identified and coded using a hybrid (deductive-inductive) thematic analysis approach with health belief model. Personal health beliefs and interpersonal support drove participation. However, structural barriers like limited awareness of TB symptoms and the TB-DM linkage, fear of nosocomial infection, logistical challenges, and financial concerns, were described as important challenges in accessing and engaging with the programme. Furthermore, Social Security Agency on Health (BPJS) coverage reduced direct screening costs, although participants described administrative and referral-related burdens. The two self-funded participants described greater flexibility in accessing services, but their experiences should be interpreted as illustrative. To optimize screening, health systems should launch targeted educational campaigns to address asymptomatic risks and fear of nosocomial infection, and streamline bureaucratic referral processes to ensure equitable access.