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

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Journal of Immigrant and Minority Health Aims and scope Submit manuscript

Abstract

Foreign-born individuals represent the majority of TB cases in the US/Canada. Little is known about their TB knowledge, attitudes, and beliefs (KAB). Cross-sectional survey was conducted in 22 sites in the US/Canada among foreign-born adults with active TB. Multiple regression was used to examine KAB factors against covariates. Of 1,475 participants interviewed, most answered the six knowledge items correctly. Significant predictors of correct knowledge included region of origin, education, income, age, visa status, place of diagnosis, BCG vaccination, and TB symptoms. Significant predictors of higher perceived risk/stigma scores included region of origin, age, place of diagnosis, English fluency, time in the US/Canada, TB symptoms, and household rooms. This study examines associations between TB KAB and patient and disease characteristics in foreign-born individuals in the US/Canada. The findings call for improved health education, along with efforts to reduce stigma and enhance realistic risk assessments.

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References

  1. CDC. Reported Tuberculosis in the United States 2010. Atlanta, GA: US Dept. of Health and Human Services. 2011.

  2. Tuberculosis in Canada, 2005. 2008. (Accessed October 2, 2012, at http://www.phac-aspc.gc.ca/tbpc-latb/pubs/tbcan08/tbcan08-es-eng.php).

  3. Kleinman A, Benson P. Anthropology in the clinic: the problem of cultural competency and how to fix it. PLoS medicine. 2006;3:e294.

    Article  PubMed Central  PubMed  Google Scholar 

  4. McEwen MM. Mexican immigrants’ explanatory model of latent tuberculosis infection. J Transcult Nurs. 2005;16:347–55.

    Article  PubMed  Google Scholar 

  5. Ailinger RL, Lasus H, Dear M. Americans’ knowledge and perceived risk of tuberculosis. Public Health Nurs. 2003;20:211–5.

    Article  PubMed  Google Scholar 

  6. Brassard P, Anderson KK, Menzies D, Schwartzman K, Macdonald ME. Knowledge and perceptions of tuberculosis among a sample of urban Aboriginal people. J Community Health. 2008;33:192–8.

    Article  PubMed  Google Scholar 

  7. Marinac JS, Willsie SK, McBride D, Hamburger SC. Knowledge of tuberculosis in high-risk populations: survey of inner city minorities. Int J Tuberc Lung Dis. 1998;2:804–10.

    CAS  PubMed  Google Scholar 

  8. Marks SM, Deluca N, Walton W. Knowledge, attitudes and risk perceptions about tuberculosis: US National Health Interview Survey. Int J Tuberc Lung Dis. 2008;12:1261–7.

    CAS  PubMed  Google Scholar 

  9. Murphy DA, Rotheram-Borus MJ, Joshi V. HIV-infected adolescent and adult perceptions of tuberculosis testing, knowledge and medication adherence in the USA. AIDS care. 2000;12:59–63.

    Article  CAS  PubMed  Google Scholar 

  10. Ailinger RL. Dear, M.R. Latino immigrants’ explanatory models of tuberculosis infection. Qual Health Res. 1997;7:521–31.

    Article  Google Scholar 

  11. Ailinger RL, Armstrong R, Nguyen N, Lasus H. Latino immigrants’ knowledge of tuberculosis. Public Health Nurs. 2004;21:519–23.

    Article  PubMed  Google Scholar 

  12. Carey JW, Oxtoby MJ, Nguyen LP, Huynh V, Morgan M, Jeffery M. Tuberculosis beliefs among recent Vietnamese refugees in New York State. Public Health Rep. 1997;112:66–72.

    CAS  PubMed Central  PubMed  Google Scholar 

  13. Joseph HA, Waldman K, Rawls C, Wilce M, Shrestha-Kuwahara R. TB perspectives among a sample of Mexicans in the United States: results from an ethnographic study. J Immigr Minor Health. 2008;10:177–85.

    Article  PubMed  Google Scholar 

  14. AhChing LP, Sapolu M, Samifua M, Yamada S. Attitudes regarding tuberculosis among Samoans. Pac Health Dialog. 2001;8:15–9.

    CAS  PubMed  Google Scholar 

  15. Coreil J, Lauzardo M, Heurtelou M. Cultural feasibility assessment of tuberculosis prevention among persons of Haitian origin in South Florida. J Immigr Health. 2004;6:63–9.

    Article  PubMed  Google Scholar 

  16. Gibson N, Cave A, Doering D, Ortiz L, Harms P. Socio-cultural factors influencing prevention and treatment of tuberculosis in immigrant and Aboriginal communities in Canada. Soc Sci Med. 2005;61:931–42.

    Article  CAS  PubMed  Google Scholar 

  17. West EL, Gadkowski LB, Ostbye T, Piedrahita C, Stout JE. Tuberculosis knowledge, attitudes, and beliefs among North Carolinians at increased risk of infection. N C Med J. 2008;69:14–20.

    PubMed  Google Scholar 

  18. Poss JE. The meanings of tuberculosis for Mexican migrant farmworkers in the United States. Soc Sci Med. 1998;47:195–202.

    Article  CAS  PubMed  Google Scholar 

  19. Juniarti N, Evans D. A qualitative review: the stigma of tuberculosis. J Clin Nurs. 2011;20:1961–70.

    Article  PubMed  Google Scholar 

  20. Kelly P. Isolation and stigma: the experience of patients with active tuberculosis. J Community Health Nurs. 1999;16:233–41.

    Article  CAS  PubMed  Google Scholar 

  21. Yamada S, Caballero J, Matsunaga DS, Agustin G, Magana M. Attitudes regarding tuberculosis in immigrants from the Philippines to the United States. Fam Med. 1999;31:477–82.

    CAS  PubMed  Google Scholar 

  22. Wieland ML, Weis JA, Yawn BP, et al. Perceptions of tuberculosis among immigrants and refugees at an adult education center: a community-based participatory research approach. J Immigr Minor Health. 2012;14:14–22.

    Article  PubMed  Google Scholar 

  23. Colson PW, Franks J, Sondengam R, Hirsch-Moverman Y, El-Sadr W. Tuberculosis knowledge, attitudes, and beliefs in foreign-born and US-born patients with latent tuberculosis infection. J Immigr Minor Health. 2010;12:859–66.

    Article  PubMed  Google Scholar 

  24. Ito KL. Health culture and the clinical encounter: vietnamese refugees’ responses to preventive drug treatment of inactive tuberculosis. Med Anthropol Q. 1999;13:338–64.

    Article  CAS  PubMed  Google Scholar 

  25. Asch S, Leake B, Anderson R, Gelberg L. Why do symptomatic patients delay obtaining care for tuberculosis? Am J Respir Crit Care Med. 1998;157:1244–8.

    Article  CAS  PubMed  Google Scholar 

  26. Healy EA. Health locus-of-control beliefs in Vietnamese clients with latent tuberculosis. Nurs Connect. 1997;10:39–46.

    CAS  Google Scholar 

  27. Sebastian MS, Bothamley GH. Tuberculosis preventive therapy: perspective from a multi-ethnic community. Respir Med. 2000;94:648–53.

    Article  CAS  PubMed  Google Scholar 

  28. Upshur RE, Deadman L, Howorth P, Shortt L. The effect of tuberculosis and tuberculosis contact tracing on school function: an exploratory focus group study. Can J Public Health. 1999;90:389–91.

    CAS  PubMed  Google Scholar 

  29. Davidow AL, Katz D, Reves R, Bethel J, Ngong L. Tuberculosis Epidemiologic Studies Consortium. The challenge of multisite epidemiologic studies in diverse populations: design and implementation of a 22-site study of tuberculosis in foreign-born people. Public Health Rep. 2009;124:391–9.

    PubMed Central  PubMed  Google Scholar 

  30. Bandura A. Health promotion from the perspective of social cognitive theory. In: Norman PAC, Conner M, editors. Understanding and changing health behavior: from health beliefs to self-regulation. Amsterdam: Harwood Academic Publishers; 2000. p. 299–339.

    Google Scholar 

  31. Becker MH. The health belief model and personal behavior. Thorofare, NJ: SLACK; 1974.

    Google Scholar 

  32. Ewart CK. Social action theory for a public health psychology. Am Psychol. 1991;46:931–46.

    Article  CAS  PubMed  Google Scholar 

  33. Fishbein M, Ajzen I. Belief, attitude, intention and behavior: an introduction to theory and research. Menlo Park: Addison-Wesley; 1975.

    Google Scholar 

  34. Bentler PM. Bonett, D.G. Significance tests and goodness-of-fit in the analysis of covariate structures. Psychol Bull. 1980;88:588–606.

    Article  Google Scholar 

  35. Browne MW, Cudeck R. Alternative ways of assessing model fit. In: Bollen KA, Long JS, editors. Testing structural equation models. Newbury Park: Sage Publications; 1993. p. 136–62.

    Google Scholar 

  36. Steiger JH. EzPATH: causal modeling. Evanston: SYSTAT; 1989.

    Google Scholar 

  37. Muthen LK, Muthen BO. Mplus User’s Guide. 6th ed. Los Angeles: Muthen & Muthen; 2010.

  38. Linacre JM. A User’s Guide to WINSTEPS & MINISTEP Rasch-Model Computer Programs: WINSTEPS.com; 2011.

  39. Janz NK, Strecher VJ. The health belief model. In: Glanz KRB, Viswanath K, editors. Health behavior and health education. 4th ed. San Francisco: Jossey-Bass; 2008. p. 45–66.

    Google Scholar 

  40. Lewis MA, DeVellis BM, Sleath B. Social influence and interpersonal communication. In: Glanz KRB, Lewis FM, editors. Health behavior and health education. 3rd ed. San Francisco: Jossey-Bass; 2002. p. 240–64.

    Google Scholar 

Download references

Acknowledgments

The authors thank the Tuberculosis Epidemiologic Studies Consortium and the Centers for Disease Control and Prevention, which supported this study. Additionally, the authors thank all the patients who have participated in this study. We also thank the investigators and staff at all the participating TBESC sites: Michael Kimerling [Principal Investigator (PI)], Ashutosh Tamhane [Project Coordinator (PC)], University of Alabama; Frank Wilson (PI), Cheryl LeDoux (PC), Arkansas Department of Health; Jennifer Flood, Sarah Royce (PIs), Katya Salcedo, Sumi Sun (PCs), California Department of Health Services; Wafaa El-Sadr (PI), Yael Hirsch-Moverman (PC), Columbia University; Randall Reves (PI), Kirsten Wall, Lourdes Yun (PCs), Denver Public Health and Hospital Authority; Henry Blumberg (PI), Jane Tapia (PC), Emory University; Jessie Wing (PI), Thara Venkatappa, Tara Nash (PCs), Hawaii Department of Health; Earl Hershfield (PI), Barbara Roche (PC), University of Manitoba; Wendy Cronin (PI), Susan Collins, Heather Rutz (PCs), Maryland Department of Health and Mental Hygiene; Robert Horsburgh, Sue Etkind (PIs), Sharon Sharnprapai (PC), Massachusetts Department of Health; Wendy Sutherland, (PI) Sarah Solarz, Hodan Guled (PCs), Minnesota Department of Health; Cynthia Driver (PI), Jiehui Li, Holly Anger (PCs), New York City Department of Health and Mental Hygiene; Margaret Oxtoby, Stephen Hughes (PIs), Wilson Miranda (PC), New York State Department of Health; Rachel Royce (PI), Juani Munoz (PC), Research Triangle Institute; Sharon Welbel, James McAuley, (PIs), Judith Beison (PC), Respiratory Health Association of Metropolitan Chicago; Jenny Pang (PI), Vijaya Rao (PC), Seattle-King County Department of Public Health; Connie Haley (PI), Trudy Stein-Hart, Katie Gordon, Tamara Chavez-Lindell (PCs), Tennessee Department of Health; Edward Graviss (PI), Smita Chatterjee, Larry Teeter (PCs), Texas Department of Health; Monika Naus, Victoria Cook (PIs), Kadria Alasaly, Maya Nakajima (PCs), University of British Columbia; David Berger (PI), Neil Abernethy, Baby Djojonegoro (PCs), University of California, San Francisco; Amy Davidow (PI), Anna Sevilla, Nandini Selvam (PCs), University of Medicine and Dentistry, New Jersey; Stephen Weis, Patrick Moonan (PIs), Guadalupe Munguia-Bayona (PC), University of North Texas.

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Authors and Affiliations

  1. Charles P. Felton National Tuberculosis Center, ICAP, Mailman School of Public Health, Columbia University, 215 W. 125th St., 1st fl., Suite A, New York, NY, 10027, USA

    Paul W. Colson & Yael Hirsch-Moverman

  2. RTI International, Research Triangle Park, NC, USA

    G. Lance Couzens, Rachel A. Royce & Tracy Kline

  3. Tennessee Department of Health, Knoxville, TN, USA

    Tamara Chavez-Lindell

  4. Rush Medical College, Chicago, IL, USA

    Sharon Welbel

  5. Group Health Permanente, Seattle, WA, USA

    Jenny Pang

  6. University of Medicine and Dentistry of New Jersey, Newark, NJ, USA

    Amy Davidow

Authors
  1. Paul W. Colson
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  2. G. Lance Couzens
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  3. Rachel A. Royce
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  4. Tracy Kline
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  5. Tamara Chavez-Lindell
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  6. Sharon Welbel
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  7. Jenny Pang
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  8. Amy Davidow
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  9. Yael Hirsch-Moverman
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the Tuberculosis Epidemiologic Studies Consortium (TBESC)

Corresponding author

Correspondence to Paul W. Colson.

Additional information

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

This study was conducted for the Tuberculosis Epidemiologic Studies Consortium (TBESC).

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Colson, P.W., Couzens, G.L., Royce, R.A. et al. Examining the Impact of Patient Characteristics and Symptomatology on Knowledge, Attitudes, and Beliefs Among Foreign-born Tuberculosis Cases in the US and Canada. J Immigrant Minority Health 16, 125–135 (2014). https://doi.org/10.1007/s10903-013-9787-7

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  • DOI: https://doi.org/10.1007/s10903-013-9787-7

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