“Ale Rasa Beta Rasa” A Cultural Value That Is Capable Of Overcoming Tuberculosis (Tb) Stigma: Qualitative Research Down In Maluku, Indonesia

Abstract

Introduction: Tuberculosis (TB) stigma is a public health issue in one of Indonesian regions, Maluku, where cultural identity highly defines the way people interact. Therefore, this study aims to determine the influence of the local value, Ale Rasa Beta Rasa or I feel what you feel, on reducing stigma connected to TB.

Methods: This was a qualitative descriptive study conducted in Ambon City, Maluku Province, in February-April 2025. A total of 25 participants were selected using the purposive sampling method, comprising TB patients, family members, academics, healthcare professionals, religious leaders, and survivors. Data was collected using participatory observation, document analysis, and in-depth interviews. In addition, the interviews were verbatim-transcribed and later thematically analyzed using the 6-phase method associated with Braun and Clarke, and the cultural context was taken into consideration.

Results: The 3 main findings included: (1) internalized form of stigma was dominant, where patients hid their illness and sought care beyond their local community; (2) the metaphor “Ale Rasa Beta Rasa” served as the way of cultural capital that induced empathy, collegiality, and social acceptance and subsequently increased the treatment adherence; and (3) religious leaders and TB patients acted as key mediators, providing both advocacy and education in terms of cultural norms and values.

Conclusions: Incorporation of cultural values in TB control strategies can be used to improve program sustainability and relevance. The results provide a culturally-based model that can direct the efforts of national stigma-reducing activities, and potentially be modified to fit the use in other communities sharing a cultural commonality. The identified structure, entitled Ale Rasa Beta Rasa, has shown significant potential related to overcoming stigma-related obstacles to treatment in contexts where cultural coherence is pertinent.