Ceylon Auguste-Nelson, BA - PowerPoint Presentation

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Ceylon Auguste-Nelson, BA

1, Carolyn Fisher, PhD1, Ranjani Paradise, PhD1, Hanna Haptu, MD2, Andrew Tibbs3, Jennifer Cochran3

Using qualitative methods to understand strategies for engaging patients in community-based latent TB infection treatment

“Like we are family”:

Roundtable Session at the American Public Health Association’s 2021 Annual MeetingEvaluation of Public Health Education and Health Promotion ProgramsOctober 25th, 2021 | 2:30 pm – 3:45 pm

1

Institute for Community Health, Malden, MA 2Lynn Community Health Center, Lynn, MA3Massachusetts Department of Public Health, Boston, MA

Background

LATENT TUBERCOLOSIS INFECTION (LTBI)

Dormant form of tuberculosis that can develop into active diseaseMost TB cases in U.S. result from untreated LTBILTBI is treated through consistent medication regimens over a set number of months

Non-US born people have a particularly high risk of LTBI

PROJECT

CDC funded Massachusetts Department of Public Health (MDPH) to conduct 3-year demonstration project (Oct 2016 – Jan 2020)

GOAL

: Scale up LTBI testing & treatment in a high-risk population

BackgroundSETTING

City: Lynn, Massachusetts1/3 of residents non-US bornIn 2015, estimated 6,000 non-US born residents with LTBI

Clinical Site

: Lynn Community Health Center (LCHC)

Largest provider of primary care and behavioral health services in LynnDiverse patient population (data as of 2015)80% racial/ethnic minorities55% best served in language other than English60% living below federal poverty limit 15% had no insurance coverage

Began testing and treating patients with LTBI in 2013

BackgroundDEMONSTRATION PROJECT COMPONENTS

Collaborative MDPH-LCHC clinical team Community engagement and educationWorkflow development and process improvementTraining and professional developmentExpanded access to care and social needs supportElectronic health record and data reporting improvementsProgram evaluation

Mixed-methods evaluation

Components:Development of LTBI cascade of care frameworkQuantitative electronic health record analysisProcess evaluation and outcomes trackingQualitative data collectionTime-tracking studyGoals:Monitor and record data on scale up implementation and outcomesInform quality improvementIdentify successful practices and lessons learned

Qualitative evaluation

Data collection activities included: Semi-structured interviews with 13 patientsSemi-structured interviews with 2 physiciansStructured interviews with 2 clinicians and 3 community health workersEvaluators used a framework analysis to extract key themes about factors supporting patient engagement in, and completion of, their LTBI treatment

Findings

Key factors in patient engagement and retention:“High touch” communication conducted by CHWs and other members of the teamWarm and trusting relationships built by LTBI clinical team with patientsFlexibility with scheduling and appointments that prioritized patients’ access to treatment

Illustrative quotes from patients

“The person who give it to me all the time, the medicine…She make me comfortable all the time, so friendly, I love her. So, she make it really easy. Sometimes it is too much medicine for me, but thanks to her she make me finish it…I really liked to come over there, even if it wasn’t easy every Thursday.”

“[When I finished treatment] I felt like crying because I know I was going to miss them…I love you guys [referencing LTBI team],

I love the way you interact with me.

I love how we talk, we chat like we are family. They were good…they are so loving there.”

Conclusion

For public health program evaluations, qualitative data is a valuable complement to quantitative epidemiological analysis. Qualitative data helps deepen our understanding of program’s efforts and outcomes and identify lessons for improvement and replication.