Understanding cultural perceptions of family support for mental health in patients with comorbid TB: A thematic analysis using Braun and Clarke's framework in Kendari, Southeast Sulawesi

Background Qualitative health research often uses thematic analysis as a procedural coding method with little emphasis on reflexivity, analytical decision-making, and theme linkages. Family support is often considered a significant finding in chronic illness research, but its use as an analytical framework for studying local perceptions of illness, caregiving practices, and family mental health support for tuberculosis patients with culturally organized comorbidities is understudied. This study solves this methodological gap by demonstrating how reflective thematic analysis (RTA) can provide culturally relevant explanations. Methods This study used Braun and Clarke’s reflexive thematic analysis to analyse semi-structured interviews with family caregivers and key informants in Kendari, Southeast Sulawesi, Indonesia. The analytical process was explicitly reflexive and interpretative, with themes being actively constructed through an iterative engagement with the data. Analytical decisions, theme development and relationships between themes were made transparent. Cultural context was treated as integral to interpretation, rather than as a background description. Results Three interrelated themes were identified through analysis. Firstly, cultural constructions of tuberculosis and comorbidities demonstrate how disease is understood through a symptom-based, culturally embedded framework that marginalises explicit mental health discourse. Secondly, family support in the form of everyday emotional and moral practices shows how care is provided through presence, motivation and practical assistance. This implicitly supports mental health without being explicitly acknowledged. Thirdly, barriers to explicit mental health support were conceptualised as analytical consequences of these constructions and practices. Conclusion This methodological paper, illustrated through an empirical case study, contributes to qualitative methodology by demonstrating the explanatory potential of reflective thematic analysis in examining naturalistic practices in family mental healthcare and support for tuberculosis (TB) patients with comorbidities. The findings emphasise the importance of analytical reflexivity, theme integration, and contextual sensitivity when using thematic analysis in health research.