Development of a tuberculosis education booklet for Latino immigrant patients

doi:10.1016/S0738-3991(01)00156-2

Patient Education and Counseling

Volume 46, Issue 2, February 2002, Pages 117-124

https://doi.org/10.1016/S0738-3991(01)00156-2 Get rights and content

Abstract

The incidence and prevalence of tuberculosis are far more common among third world populations immigrating to the United States than among US-born citizens. Immigrants’ failure to comply with an anti-tuberculosis treatment can impede completion of care and further confound this public health problem. Barriers to patient–provider communication can negatively influence adherence to a medical regimen. Patients who are unable to comprehend medical advice and do not see it as personally salient are less likely to follow their provider’s medical advice. In this paper, the authors focus on efforts to develop a patient education tool targeting Spanish-speaking Latino immigrant patients to facilitate communication with tuberculosis clinicians. A description of the multi-stage developmental processes is presented including conducting a needs assessment, development of visual and written messages, review/critique by tuberculosis experts, field-testing, revisions, and distribution. Formative evaluation and field testing indicates promise for improving communication using this tool.

Introduction

While national trends of tuberculosis (TB) cases among persons born in the United States have been declining since 1992, the level among foreign-born persons living in the US appears to be increasing [1]. The CDC [1] estimates that among immigrants to the US the TB case rate is three times greater than among US-born individuals. The explanation for this occurrence is that the case rates of TB are higher among immigrants from countries where the incidence rate is higher than in the US [2]. Indeed, TB in developing countries still continues to be recognized as an international threat to public health [3]. Thus, US communities that are a port of entry for immigrants are at higher risk for exposure to TB.

High-risk patients’ failure to comply with anti-tuberculosis treatment further confounds efforts to control this infectious disease. Non-adherence is defined as a failure to consistently take medication, keep scheduled medical appointments, and complete treatment within a prescribed period of time. Despite the advent of highly effective chemotherapeutic regimens in the treatment of TB, it is estimated that at least 20–50% of patients fail to comply with their prescribed treatment regimen [4]. Non-adherence has been reported to be higher among immigrant patients compared to US-born patients [5].

Section snippets

Background

An important component of this complex problem of non-adherence is a breakdown of patient-health care provider communication. Indeed, poor patient–provider communication has been identified as a major factor in patient non-adherence [6]. Conversely, improved communication may lead to increased adherence and ultimately to better health outcomes [7].

TB-control programs have been encouraged to address barriers that are thought to impede completion of care for foreign-born patients [8]. These

Project design

This descriptive study used both quantitative and qualitative research processes to conduct formative evaluation on a supplemental educational pamphlet. The process followed a multi-stage sequence of activities.

Following the review of TB-related knowledge, attitudes, beliefs, and behaviors (KABB) studies among Latino immigrants, the developmental process included the following components: stage I—descriptive stage is developing, administering, and analyzing a KABB survey of patients being

Practice implications

Current centers for disease control treatment guidelines recommend that active TB must be treated at least 6 months for most patients [36]. For vulnerable populations to benefit from extended anti-tuberculosis treatments, one must ensure adherence to therapy. Efforts to educate patients about the necessity for completing care in a timely fashion must be matched with attempts to understand, motivate, and better reach TB active patients who may have to overcome a number of social and economic

Acknowledgements

Grant R01-NR/DA 03720 from the National Institutes of Nursing Research and National Institute of Drug Abuse and National Heart, and (RO1-HL 55770-02S1) from the Lung & Blood Institute.

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Development of a tuberculosis education booklet for Latino immigrant patients

Abstract

Introduction

Section snippets

Background

Project design

Practice implications

Acknowledgements

Respir. Med.

Soc. Sci. Med.

Soc. Sci. Med.

Tubercle Lung Dis.

Soc. Sci. Med.

Patient Educ. Couns.

Tuber Lung Dis.

Enhancing patient compliance with tuberculosis therapy

Clin. Chest Med.

Adherence to tuberculosis preventive therapy among Latino immigrants

Public Health Nurs.

Health care utilization, family context, and adaptation among immigrants to the United States

J. Health Soc. Behav.

Acculturative stress: the experience of the Hispanic immigrant

Couns. Psychol.

The impact of language as a barrier to effective health care in an underserved urban Hispanic community

Mt. Sinai. J. Med.

The ethnomedical model as a conceptual tool for counselling in health-care decision-making

Br. J. Guid. Couns.