Improving Infectious Tuberculosis Education and Counselling in Calgary for Patients who are Foreign-born and their Families

Patients and family members require comprehensive information and support to manage tuberculosis (TB). However, current TB education and counselling practices often fail to address family needs. This is particularly true in low TB incidence settings such as Canada, where linguistic and cultural dissonance between patients and providers is common. The objective of this research was to explore how TB health care workers (TB HCWs) and health systems leaders can focus education and counselling on the needs and preferences of patients and family members who are foreign-born experiencing advanced infectious TB in Calgary, Canada. The case study was conducted in three phases framed on the Social Ecological Model. In phase one, interviews were conducted with patients and family members to learn about their TB-related needs and experiences. In phase two, staff and physicians at the Calgary TB Clinic were interviewed to learn about their perceptions of barriers and supports to education and counselling for this group. In phase three, data from the first two phases were re-analyzed, relevant documents were reviewed, and health services and community leaders were interviewed to learn how health policy and social context influence education and counselling. Patients and family members described significant isolation associated with TB. Although patients and family members were satisfied with education and counselling, there was evidence that communication problems had occurred. TB HCWs reported numerous, multi-level barriers to providing education and counselling but found that continuity of care and clear information provided early reduced communication problems. Data from community leaders’ interviews and document review revealed that operational and public health priorities often took precedence over strengthening education and counselling. Leaders noted promising developments had recently increased attention to the needs of people who are foreign-born. Key recommendations for change include development of patient education and counselling guidelines, improved patient teaching materials, and offering a cultural patient navigator to families affected by advanced infectious TB. Adopting these changes could reduce fear and isolation in patients and family members; however, policy changes is required to realize the equity-enhancing potential of informing and supporting patients and family members affected by TB.

Name thesis:degree_name

Doctor of Philosophy (PhD)

Discipline thesis:degree_discipline

Medicine – Community Health Sciences

Grantor dc:publisher.institution

Cumming School of Medicine

Year dc:date.issued

2022

Author dc:creator

• Bedingfield, Nancy Joyce

Advisor dc:contributor.advisor

• King-Shier, Kathryn

Committee members dc:contributor.committeemember

• Fisher, Dina
• Lashewicz, Bonnie

• tuberculosis
• patient education and counselling
• patient and family centred care
• qualitative methods

Statement dc:rights

• University of Calgary graduate students retain copyright ownership and moral rights for their thesis. You may use this material in any way that is permitted by the Copyright Act or through licensing that has been assigned to the document. For uses that are not allowable under copyright legislation or licensing, you are required to seek permission.

Language dc:language.iso

eng

DOI

https://dx.doi.org/10.11575/PRISM/39957

OAI identifier oai:identifier

oai:ucalgary.scholaris.ca:1880/114908