DOI: 10.12688/wellcomeopenres.27420.1 ISSN: 2398-502X

Why Do Migrants Choose to Receive Months-Long Tuberculosis Treatment at a Sanatorium? A Qualitative Exploration of Migrant Care-Seeking for Tuberculosis Diagnosis and Treatment in Tak Province, Thailand

Jindaporn Wirachonphaophong, Hai Ti Ti, Nay Kaw Htoo, Kanjana Winyoorat, Cha Ba, San Soe, Suphak Nosten, Htet Ko Ko Aung, Sein Sein Thi, Decha Tangseefa, Ahmar Hashmi, Francois Nosten
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Introduction Migrant populations along the Thailand-Myanmar border face major barriers to tuberculosis (TB) diagnosis and treatment, including cost, undocumented status, transportation, and limited health literacy. This study explored the factors influencing migrant patients’ decisions to accept treatment at a TB sanatorium in Tak Province, Thailand. Methods This multi-perspective qualitative study was conducted between March and November 2025. Focus group discussions and in-depth interviews were conducted with patients receiving TB treatment and healthcare workers involved in TB care. Data were audio-recorded, translated, transcribed, and analyzed thematically using both an open- and deductive coding approach within a constructivist framework. Results A total of 37 patients and five health workers participated in FGDs and IDIs. A total of 37 patients and five health workers participated in FGDs and IDIs. Three themes explained treatment decision making: a strong desire for cure, barriers to accessing diagnosis and treatment, and community and organizational support that helped overcome these barriers. Participants described cure as relief from symptoms, protection of the family and community from TB transmission, and a path back to work and economic stability. Major barriers include direct medical costs, indirect costs from lost income and transportation expenses, fear of police due to undocumented status, and limited awareness of options for TB diagnosis and treatment. Support from family, community members, employers, and trusted organizations facilitated care-seeking. Free treatment, arranged transportation, food, housing, and treatment completion certificates further encouraged adherence. Conclusions For mobile migrant populations, sanatorium-based TB care addresses critical structural and social barriers to diagnosis and treatment. The model was acceptable because it combined free, trusted, and supportive care with practical assistance, which enabled patients to complete long courses of treatment.

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