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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
E-mail: rbk5@cdc.gov
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
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