Perceptions of Tuberculosis Among Immigrants and Refugees at an Adult Education Center: A Community-Based Participatory Research Approach

Abstract

English as a Second Language programs serve large foreign-born populations in the US with elevated risks of tuberculosis (TB), yet little is known about TB perceptions in these settings. Using a community-based participatory research approach, we elicited perceptions about TB among immigrant and refugee learners and staff at a diverse adult education center. Community partners were trained in focus groups moderation. Ten focus groups were conducted with 83 learners and staff. Multi-level, team-based qualitative analysis was conducted to develop themes that informed a model of TB perceptions among participants. Multiple challenges with TB control and prevention were identified. There were a variety of mis-perceptions about transmission of TB, and a lack of knowledge about latent TB. Feelings and perceptions related to TB included secrecy, shame, fear, and isolation. Barriers to TB testing include low awareness, lack of knowledge about latent TB, and the practical considerations of transportation, cost, and work schedule conflicts. Barriers to medication use include suspicion of generic medications and perceived side effects. We posit adult education centers with large immigrant and refugee populations as excellent venues for TB prevention, and propose several recommendations for conducting these programs. Content should dispel the most compelling misperceptions about TB transmission while clarifying the difference between active and latent disease. Learners should be educated about TB in the US and that it is curable. Finally, TB programs that include learners and staff in their design and implementation provide greater opportunity for overcoming previously unrecognized barriers.

Barriers and facilitators to the uptake of tuberculosis diagnostic and treatment services by hard-to-reach populations in countries of low and medium tuberculosis incidence: a systematic review of qualitative literature

“…Of ten studies evaluating the views of individuals belonging to hard-to-reach populations on TB and TB services, seven were views of migrants, 15,29,31,34,35,37,38 one a mixed group of homeless people, migrants and drug users, 28 one of homeless people, 32 and one study reported on views of a Roma population. 36 No studies were found on views of prisoners, sex-workers and children living in hard-to-reach populations.…”

“…We included seven studies that reported views of hard-to-reach people regarding TB susceptibility, such as concepts of causes, risk factors, and modes of transmission. 15,28,29,31,34,36,38 Six studies focused exclusively on migrant populations, 15,29,31,34,36,38 and one on a mixed population of homeless people, drug users and migrants. 28 Smoking and 'other illnesses' were the most frequently mentioned perceived causes or risk factors for TB.…”

“…13,28,34,36 Other frequently perceived causes mentioned by individuals from hard-to-reach populations were: (i) food-related causes (usually 'bad', or a lack of food); 15,28,36 (ii) the misconception that TB 'is in the blood ' A frequent misconception among migrant students and teachers at an adult education centre in the USA was that TB was not present in the USA. 15 Zuñiga et al 29 reported that some of the interviewed MexicanAmerican TB-patients talked about being vulnerable to TB because of the proximity to Mexico. In a mixed group of homeless, drug using and migrant TB patients in London, UK, knowledge of TB was generally limited, and a wide variety of causes was mentioned.…”

“…Five studies reported on the views of hard-to-reach people on the severity of TB, such as symptoms, health consequences, and treatability of TB. 15 Similarly, a Roma population in Belgrade had accurate knowledge of symptoms. However, views on severity and the effectiveness of treatment varied, ranging from TB being a very serious and lethal disease to a long-lasting, but curable disease.…”

“…36 A mixed group of migrants in the USA reported fear of TB, which consisted mainly of fear of dying from an incurable disease. 15 Erroneous explanations for (common)…”