Decolonising Tuberculosis Treatment Pathways: A Participatory Action Research (PAR) Approach Within the Western Cape, South Africa

Tuberculosis (TB) continues to pose a major public health challenge in South Africa, particularly in the Western Cape, which records some of the country’s highest TB incidence rates. Despite well-established TB control programmes, treatment access and adherence remain uneven due to structural barriers such as stigma, non-medical patient costs, and rigid clinical routines. Understanding how patients navigate these constraints is essential to improving TB treatment delivery and health outcomes. This paper outlines the qualitative methods used to create a taxonomy of pathways that patients use to access first-line TB treatment in the Western Cape, South Africa. The study was conducted in one substructure of the Cape Metropolitan region and demonstrates a methodological approach that co-creates research with frontline TB staff and key TB stakeholders to ensure that findings are contextually grounded and relevant to real-world service delivery. Using a participatory action research (PAR) framework, combined with a single-round Delphi approach and the SynNovation technique, the study systematically validates consensus among frontline TB staff on process mapping, prioritisation, feasibility, and the impact of TB treatment pathways currently used in the Western Cape. A consensus-building workshop incorporating the SynNovation technique enabled participants to refine and rename the identified pathways, promoting both cultural relevance and linguistic neutrality. The resulting taxonomy reflects staff-derived insights into TB treatment delivery and offers a foundation for future validation from patients. This study represents an initial but meaningful step toward practical decolonisation, as it repositions implementers of TB care as co-creators of knowledge and language.