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Enabling the Public and Partners:Delivering the Message of TB
John BernardoPulmonary Center
Boston University School of Medicine
October 6, 2016
Objectives
Upon completion of this presentation, you will be able to:• Explain the significance of presenting TB
data effectively; and • Describe how educating the public and
partners about TB can advance the goal of TB elimination
Your Audience
The Public• Communities (groups) at-risk• The population at-large
Health Providers• Direct care• Public Health
Policy Makers• Jurisdictional, national
We ALL are partners
The Public: Communities
Understand priorities and needs of your people• Where does your message fit?
How do people get health information?• What medium is best for communication?• Whom do they trust?
Develop credibility Introduce your message
Personal Barriers to TB Prevention and Treatment Knowledge/beliefs about TB infection,
prevention, disease, transmission Perceived consequences about TB and its
prevention or treatment Social, clinical
Attitudes towards seeking treatment: Realities and conflicting priorities Fears Limited access to care Loss of income - inability to work
Meet Your Population Engage community
groups and events• Churches, CBO’s,
health fairs … Put a face to the
message
Focus Groups• Identify barriers
before you can devise strategies Existing health
beliefs; stigma Previous history
You just may develop a nose for this business!
Identify “gate-keepers”• Trust
Take advantage of preferred media:• Newspaper, TV,
radio, corner market, barber shop
You may be surprised at what you learn………
“…You are the white people in the white coats…in the white building…”
“Research is when you experiment on people who cannot tell on you…”
“My skin test means that my vaccine is working.”
“How come your medicine is the right one and mine isn’t?”
TB Prevention in the Homeless
Communities: at-risk
The Message:• Engage your people• Develop dialog, trust• Provide access - on their terms
The Outcome:• Access to reliable information, services• Better understanding of TB• Improved Public and Personal Health
Are YOU prepared for this?We are just getting word about a case of highly infectious tuberculosis that was just diagnosed at Jamaica High School! Parents are concerned!
The Public Perceptions about TB: TB??? What???
Develop plan for unexpected events• Identify responsible personnel, protocol• Anticipate: “High-Profile” notifications• Maintain contacts with media: Be available
Leverage data into a positive message• Provide accurate information: The TRUTH • Maintain control
Educate: Social Media; Marketing• NTCA/StopTB USA: Patient Forum• Facebook: TB Photovoice Rachel Orudno: TB Photovoice
The Public: at large
The Message:• Be pro-active
Opportunities to engage public Anticipate needs, events
• Provide reliable, timely information Improves awareness of the disease Reduces fears, stigmatization
The Outcome:• Recognition of Public Health, TB• Facilitates advocacy
Providers: Direct Care Competing priorities in clinical care Poor understanding of epidemiology of
TB in their population and area• Lack of information
Poor training – clinical and public health• Medical, nursing schools• Residency, fellowship programs
Lack of resources• Radiography, laboratory, outreach
They just don’t see it!
Direct Care Providers Identify providers to at-risk groups
• Where do people usually get care?
Engage health care systems• Define needs, resources, expertise
Develop education programs: Competence• Base it on Evidence – be Credible!!• Adapt educational strategy to need:
Academic Detailing in ED’s, Lunch didactic or workshop, …
Be a presence• Regular inservices/updates; service evaluations
Be available !!!
It always comes down to….
EDUCATION………
EDUCATION……..
EDUCATION………
… and knowing where to turn when you need help!
Providers: Public Health
TB is a victim of its own being• Unique in clinical and public health domains
Yet, TB Programs are being subsumed• “Program Integration”• Private Sector: “Everyone is insured”
Need to “Manage Up”• Educate Public Health decision makers• Inform and educate Legislators
Public Health
Maintain visibility• Interact with collaborating programs and
management to foster understanding of the unique needs of Public Health-TB: Politics
• Participate in Public events Health Promotions, World TB Day
Assure competence• Clinical, laboratory, and public health
Assure access to services• Remove barriers: social, behavioral, financial
Providers and Public Health
The Bottom Line:• We are the Safety Net• OUR PATIENTS’ NEEDS HAVE TO BE MET,
OR …
Community-Based TB Prevention, Boston
Health Centers are located in high risk communities
Community members may or may not access local Health Center
Providers may not be aware of TB risk around them
Providers and staff are not educated in TB
Other, more important things to do
Community-Based TB Prevention
Identify communities at-risk Engage local Health Center Conduct Needs Assessments
• Community• Health Center providers, staff
Educate• Community via trusted channels• Health Center – regular inservices
Develop program• One size does not fit all
Be available, friendly
Community-Based TB Prevention, Boston
Neighborhood Health Center BMC-TB Clinic
PPD + Evaluation- Chest Radiograph- Medical evaluation by Pulmonary MD, BUSM- Baseline LFT’s- TB/HIV education (HIV counseling/testing)- Follow-up appointment at NHC
Monthly follow-up at NHC- Assess adherence- Evaluate for side effects- Address other health care issues- Reinforce TB education- Dispense medications (DOPT if necessary)- Forward documentation to TB Program Monitor
- Monthly evaluations, provide medications- Completion of therapy for LTBI- Feedback to NHC- Education program for NHC staff
1996; TBAA, NHLBI HL-33035
Completion of Treatment for LTBIBMC vs NHC
n: BMC: 187; NHC:187
BMC NHCSite
0
20
40
60
80
Per C
ent C
o mpl
e tio
n
(73)
(136)
Barry Chin, Boston Globe, 10/15/2008
TB Is Where You Look For It!
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