Project Title: Perceptions of Tuberculosis (TB) Among Foreign-born Persons: An Ethnographic Study

Principal Investigator(s): Robin Shrestha-Kuwahara, MPH and Heather Joseph, MPH1

Project Dates: 2002-2004

Background: This project aimed to assess the TB-related attitudes and beliefs of foreign-born persons in the United States. Preliminary findings from in-depth interviews conducted among persons (with and without TB disease) from China, Laos, Mexico, Somalia, and Vietnam suggested that the majority of respondents were aware that TB is a lung disease associated with coughing and is "caught from the air." However, there were divergent perceptions about transmission, which were often related to English ability, literacy, and educational attainment. Ideas about TB etiology, transmission, and prevention were frequently multifaceted, combining elements from biomedical and traditional perspectives. Concern about TB stigma was universal, though in varying degrees across the groups. Anticipated stigma appeared greater than that actually experienced by those with active TB. Descriptions of treatment experiences revealed a range of difficulties, from confusion about necessity of medication to side effects. Those with latent TB infection more often communicated negative feelings about medication compared to those with active TB disease.

Objectives: To understand how tuberculosis is perceived by foreign-born persons in the United States, and to identify barriers and facilitators related to TB care-seeking behaviors among these persons.

Target Audience: Foreign-born populations in the United States

Methods: In four U.S. cities, locally hired bilingual/bicultural researchers conducted a total of 200 in-depth interviews with persons recruited either from a local health clinic or directly from local communities. Participants were born in China, Laos, Mexico, Somalia, or Vietnam. Attitudes and beliefs about TB, traditional healing, stigma, TB history, experiences with services, and informational needs were assessed. Additional staff interviews and clinic observations were conducted at each site.

Results: Across the groups, structural issues, such as lack of health insurance and transportation, frequently emerged as barriers to care. Respondents clearly wanted more TB information. A combination of education strategies was identified as being the most effective, owing to illiteracy and English ability. Understanding the range of cultural, organizational, and structural issues that emerged from this study will assist local health departments in developing effective, culturally appropriate strategies to better serve these diverse populations. Ethnographic guides for programs serving the communities studied are being developed and reviewed.

Contact Information:
Robin Shrestha-Kuwahara, MPH
Behavioral Scientist
Centers for Disease Control and Prevention
Division of Tuberculosis Elimination
1600 Clifton Road, NE, Mailstop E-10
Atlanta, GA 30333

Publications: Several manuscripts are currently being drafted that focus on specific groups included in this study.

Relative Content:

1 Division of Tuberculosis Elimination, Centers for Disease Control and Prevention