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

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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 misperceptions 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.

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Acknowledgments

The authors would like to thank the HEC learners and staff and community volunteers who participated in this project. The authors also acknowledge with gratitude the role of Richard Krueger, PhD, for his role in training the focus groups facilitators, as well as Kevin Kenny, PhD and Amina Arte for their role in data analysis. Finally, we thank the community focus group moderators for their time and expertise. This project is supported by the National Institutes of Health (NIH) through a Partners in Research grant, R03 AI082703, and by Grant Number 1 UL1 RR024150* from the National Center for Research Resources (NCRR), a component of the NIH, and the NIH Roadmap for Medical Research.

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Authors and Affiliations

  1. Primary Care Internal Medicine, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN, 55904, USA

    Mark L. Wieland

  2. Research Services: Center for Translational Sciences Activities (CTSA), Mayo Clinic College of Medicine, Rochester, MN, USA

    Jennifer A. Weis

  3. Olmsted Medical Center, Rochester, MN, USA

    Barbara P. Yawn & Susan Bertram

  4. Winona State University, Rochester, MN, USA

    Susan M. Sullivan

  5. Mayo Clinic College of Medicine, Rochester, MN, USA

    Kendra L. Millington

  6. Behavioral Health Research, Mayo Clinic College of Medicine, Rochester, MN, USA

    Christina M. Smith

  7. Hawthorne Education Center, Rochester, MN, USA

    Julie A. Nigon

  8. Infectious Diseases, Mayo Clinic College of Medicine, Rochester, MN, USA

    Irene G. Sia

Authors
  1. Mark L. Wieland
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  2. Jennifer A. Weis
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  3. Barbara P. Yawn
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  4. Susan M. Sullivan
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  5. Kendra L. Millington
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  6. Christina M. Smith
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  7. Susan Bertram
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  8. Julie A. Nigon
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  9. Irene G. Sia
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Correspondence to Mark L. Wieland.

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Wieland, M.L., Weis, J.A., Yawn, B.P. et al. Perceptions of Tuberculosis Among Immigrants and Refugees at an Adult Education Center: A Community-Based Participatory Research Approach. J Immigrant Minority Health 14, 14–22 (2012). https://doi.org/10.1007/s10903-010-9391-z

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  • DOI: https://doi.org/10.1007/s10903-010-9391-z

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