Latino Immigrants' Explanatory Models of Tuberculosis Infection

Abstract

One third of the world's population is infected with the tuberculosis (TB) bacillus, and the disease accounts for more than $700 million annual U.S. health care expenditures. Only about 3% of that amount is spent on preventive therapy. The major problem with preventive therapy is lack of adherence among high-risk groups, such as Latino immigrants. To improve adherence, public health professionals need a better understanding of the meaning of tuberculosis infection to Latino immigrants. In this study, Kleinman's frame-work for eliciting an explanatory model was used in interviews with 65 Latino immigrants enrolled in preventive therapy in a county health department. The focus of the interview was their beliefs concerning the cause of their infection, their fears about it, and the results they hoped to achieve in preventive therapy. Among other findings, the study indicated that most of the immigrants did not know the cause of their infection.

Examining the Impact of Patient Characteristics and Symptomatology on Knowledge, Attitudes, and Beliefs Among Foreign-born Tuberculosis Cases in the US and Canada

“…Many foreign-born individuals perceive that TB may be brought on by a combination of factors, including behavioral factors that stress the body such as cigarette smoking, alcohol consumption, heavy manual labor, poor nutrition, and lack of adequate sleep; or environmental factors such as exposure to germs, contaminated objects or infected patients, unhygienic living conditions, and the inhalation of cold or dirty air [10–12]. Although TB is understood to be infectious, exact means of transmission are unclear [8, 11, 13].…”

“…Some individuals relate their positive skin test result to receipt of the BCG vaccination [10]. For others, the vaccine is thought to confer lifelong immunity against TB [18].…”

Adherence to Latent Tuberculosis Infection Therapy Among Latino Immigrants

“…No mid-course data are yet available. Adherence is a particularly difficult problem in immigrant groups because preventive measures are a low priority to people who are adjusting to a new country and may have different beliefs about LTBI (Ailinger & Dear, 1997). Unlike active TB, LTBI is asymptomatic, with no physical manifestations to motivate clients to adhere to prescribed therapy.…”

Tuberculosis Knowledge, Attitudes, and Beliefs in Foreign-born and US-born Patients with Latent Tuberculosis Infection

“…Evidence suggests that knowledge, attitudes, and beliefs (KAB) related to TB disease and LTBI may also impact on patients' willingness to complete LTBI treatment. These include: partial understanding of TB risk, transmission, and treatment [6–14]; unfamiliarity with the distinction between asymptomatic infection and active disease [6, 7, 9, 15]; the belief that the Bacille Calmette-Guerin vaccine (BCG), widely used in countries where TB is endemic, is protective of TB in adults and will cause a positive tuberculin skin test [15, 16]; deep concerns about TB-related stigma [10, 17, 18]; dissatisfaction with available health care for TB [19–21]; and use of culturally-specific remedies and adjuvant therapy [10, 17, 19]. …”