The Tuberculosis Behavioral and Social Science Research Forum Proceedings
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Section II. Presentations and Panel Discussions
Neighborhood Health Messengers: Using Local Knowledge, Trust, and Relationships to Create Culturally Effective Tuberculosis Education and Care for Immigrant and Refugee Families
Stefan Goldberg, M.D.
(on behalf of Patrick Chaulk, M.D., M.P.H.), Medical Officer, Clinical and Health Systems Research Branch, Division of Tuberculosis Elimination, Centers for Disease Control and Prevention
Day 1, Morning Session
Dr. Goldberg described a research project that utilized neighborhood health messengers, or “cultural case managers,” within a bilingual, bicultural TB control and prevention program, using local knowledge to create trust and relationships among immigrants and refugees. He provided details on two different cultural case management LTBI treatment programs: one in Seattle, WA, for new refugees and immigrants, and one in Boston, MA, for the Haitian community.
Based on experience in the Seattle project, the following factors emerged as attributes of effective cultural case managers:
- Having sufficient knowledge of the languages of target populations to formulate understandable and credible messages;
- Having experience with establishing effective and mutually trusting relationships with the target community;
- Being highly regarded in the target community, and therefore able to be trusted messengers in the community; and
- Being able to educate target communities about public health strategies and the complex health care system.
The Seattle program achieved a therapy acceptance rate of 88% and a therapy completion rate of 82%. Interviews suggested that the success of this program was largely due to the outreach workers’ ability to build trusting relationships with their clients.
The Haitian Collaborative Project in Boston conducted community mapping activities as part of its cultural case management project. Dr. Goldberg offered the following selected cultural findings for this project:
- TB can be more stigmatizing than AIDS.
- There is no framework for understanding “latent TB infection.” Offering treatment in the absence of patient symptoms may be seen as experimentation.
- Pharmaceuticals are often considered dangerous.
- There is widespread mistrust of American physicians.
- Health beliefs are often complex and may involve secular or spiritual components.
- Some words and phrases such as “negative” and “positive” test results may be difficult to translate or have unintended or unclear meanings.
- Perception that a positive reaction to the tuberculin skin test is common. In some populations, this is perceived as “normal” or a result of childhood vaccination with BCG.