Applying the socioecological framework as a methodological approach to combat chronic diseases challenges: a case-in-point illustration using a narrative review of factors for tuberculosis medication non-adherence in India

The “slow-moving disaster” of chronic diseases has wide-ranging social implications. While prevention of chronic diseases has shifted from individual behavioral interventions to broad socio-ecological interventions, an organizing framework for complex chronic disease situations could prove to be valuable. In this article, we proposed the socio-ecological framework as one solution to identify gaps at multiple levels and guide further research, intervention efforts, and policy direction for individual chronic diseases. We illustrate this through a case-in-point example in the form of a narrative review of factors of nonadherence to therapy for tuberculosis in India. A literature search was conducted within PubMed, Scopus, Cinahl, Medline, and the Penn State Harrell Library Resources to identify peer-reviewed articles emanating from India describing factors associated with nonadherence to tuberculosis medications. The factors for non-adherence to tuberculosis medication were reported and described as individual (age, gender, religion, socioeconomic status, etc.), interpersonal (patients, family, & friends, stigma & discrimination, patient-provider relationship, etc.), organizational, community and policy levels of the socioecological model. Furthermore, gaps in the literature pertaining to these factors of nonadherence were also identified and categorized at each level of the socioecological model. The socio-ecological framework has the potential for broader and more comprehensive application to other chronic diseases and the problems associated. Integrating and conceptualizing these contributors organizes the complexities around chronic diseases that may, in turn, inform various policymakers, researchers, program implementation experts, and field personnel in formulating the desired strategy to combat the challenges.