Tuberculosis Knowledge, Awareness, and Stigma Among African-Americans in Three Southeastern Counties in the USA: a Qualitative Study of Community Perspectives

Abstract

To inform strategies to address the tuberculosis (TB) excess among US-born African Americans, we sought to understand the TB experience in the most highly-affected Southeastern communities. We conducted semi-structured interviews and focus groups in three communities with a TB excess - urban (Georgia and Tennessee) and rural (North Carolina). Participants from five groups provided diverse perspectives – African Americans: patients with TB disease or latent TB infection (LTBI), or at high risk of contracting TB; and local community leaders and TB program staff. Few differences emerged between sites. Many participants demonstrated low levels of knowledge and awareness and held many misconceptions about TB. Patients expressed a preference for verbal communication of medical information. Patients reported fear of stigmatization and shunning, but few experienced discrimination. Patient trust for TB program staff was high, though community leaders often assumed the opposite. The findings will help guide interventions to improve knowledge and awareness regarding TB, including specific attention to the role of public and private health care providers in dispelling persistent misinformation about TB. The insight from these communities will help build the scientific foundation required to effectively eliminate health inequities.

The Intervention Strategies To Reduce Tuberculosis Stigma Based On Community: A Systematic Review

“…Health education concerning TB stigma can educate people as well as reduce TB stigma since some people are still not well-informed about TB. Three studies in this literature review show one effective intervention strategy to reduce TB stigma, which is by giving health education to TB patients, family, health workers, and society as an attempt to raise awareness (Hidayati, 2015;Misir, 2013;Royce et al, 2017).…”

Knowledge, attitudes, beliefs, and stigma related to latent tuberculosis infection: a qualitative study among Eritreans in the Netherlands

“…This is in line with a previous study among Chinese immigrants in Canada, which linked LTBI related stigma to limited knowledge about LTBI and confusion with TB disease. (15) Although interviewees experienced felt and enacted stigma, which could impede treatment start and completion (27,28), their strong motivation to prevent becoming sick with TB and complete their treatment resulted in high uptake and completion rates. (9,29) TB and LTBI education provided throughout the cascade of care improved knowledge, however, did not prevent stigma.…”

“…(25,33) To successfully implement TB prevention programs and to overcome persisting stigmatizing community norms about TB, evidence-based interventions focused on knowledge-shaping and attitude changing are needed. (27,32,34) Although TB treatment support interventions reducing stigma have been described (26)(27)(28)34), there is a lack of evidence on effective interventions for persons on LTBI treatment. Moreover, if LTBI treatment support is in place at all, very few countries provide education and psycho-emotional support to those on LTBI treatment.…”

Knowledge, attitudes, beliefs, and stigma related to latent tuberculosis infection: a qualitative study among Eritreans in the Netherlands

“…This is in line with a previous study among Chinese immigrants in Canada, which linked LTBI related stigma to limited knowledge about LTBI and confusion with TB disease. (8) Although interviewees experienced felt and enacted stigma, which could impede treatment start and completion (25,26), strong motivation resulted in high uptake and completion rates. (16,17) To successfully implement TB prevention programs and to overcome persisting stigmatizing community norms about TB, interventions focused on knowledge-shaping and attitude changing are needed.…”

“…(25,27) Educators -such as TB care staff and community-workers-should appropriately portray messages: emphasizing the contagiousness of TB rather than effective prevention measures may fail to subduct stigmatizing behaviours and could create even more fear. (23,28) Although TB treatment support interventions reducing stigma have been described (24)(25)(26)(27), there is a lack of evidence on effective interventions for persons on LTBI treatment. Moreover, if LTBI treatment support is in place at all, very few countries provide education and psycho-emotional support to those on LTBI treatment.…”