For a disease that can be devastating to the lungs, the abstract medicine of words and knowledge cures much more effectively than a stethoscope.Christopher Prater
WashU researchers and Vitendo4Africa say that a collaborative study funded by the Center for Community Health Partnership & Research has resulted in increased discussion, diagnosis and treatment of tuberculosis in the St. Louis Kenyan-American community. The project, entitled, “Creating a Shared Understanding of Health Beliefs to Improve Health Outcomes for Immigrants: A Model for Reciprocal Health Education between Community and Health Care Providers” aimed to train community health workers to facilitate in-home discussion with community residents that “promotes health, diminishes cases of tuberculosis (TB), and strengthens community relationships”.
The project has grown into a much larger collaboration of community, research and education about good health practices. According to investigators, the project is a “great example of collaborating and combining resources to solve a public health concern in the community.”
We caught up with Chris Prater, MD, assistant professor in medicine and pediatrics at the School of Medicine, Institute Faculty Scholar, and the lead investigator on the project:
What was the impetus for this particular research project?
Geoffrey (Soyiantet, president of Vitendo) approached me after an introduction by the Center for Community Health Partnership & Research at the Institute for Public Health. He discussed a health concern that tuberculosis (TB) had recently caused infections and death in the African community of St. Louis. He wanted to plan a community-based project, and at the time, I was looking to start a long-term partnership in the immigrant health field. I am also a tuberculosis physician for the City of St. Louis Department of Health. If there were a research dating app linking academics to community organizations, we would have been perfect matches.
What was your general objective of the research and were your goals met?
Our primary objectives were to raise awareness and reduce stigma of TB in the African community. We trained community members as lay health workers to lead group-education sessions about TB. To date, we have trained 10 community members who are now local, culturally congruent experts. More than 100 individuals have been educated about TB, but the actual number is likely much more than this, as word of mouth in the African community can drive health education. In our first intervention cycle, 20 out of 32 participants reported that they had already spoken to at least one friend or family member about TB.
On a scientific level, we aimed to increase TB knowledge and self-efficacy for testing in the participants. Self-efficacy in our study was measured as motivation and planning to get a TB test. Foreign-born individuals are disproportionately infected with TB, and thus diagnostic tests are important for this subpopulation. It is also important to understand that TB disease is almost always a reactivation of an old infection that had been dormant for many years. During those “latent” years, it is important to detect the TB with a test and treat with medicine before a person develops symptoms. TB is a deadly disease, and kills about 14% of its victims globally. So early diagnosis and treatment in its latent phase is key to good outcomes.
We had hoped to have up to 200 individual participants at this point, but the pandemic is a big barrier to a group-based home intervention. Virtual meetings haven’t had the same enthusiasm or effect, so, there are always more goals to achieve.
What were your primary findings as a result of the project?
- Participants in our groups improved their knowledge of TB two months after the education session by eight percentage points. This might not seem like a large increase, but equates to answering two additional questions correct on our test.
- Participants in our group increased their self-efficacy to get tested after the intervention and would be more likely to complete their TB treatment if diagnosed.
- We proved that an academic institution and community nonprofit could successfully partner and establish a healthy, longitudinal relationship. Historically this has not always been an easy task, as often researchers drive the research questions, intervention, and outcomes. This was a partnership – we made every decision together or in consultation with a community advisory board. It’s now three years later, and we’re on our third iteration of the intervention model.
- We’ve learned how to problem-solve together. We even have partnered on other projects, and will be attending the annual APHA conference together in October for a project about COVID’s impact in the African community. We’ve attended workshops together. We’ve met each other’s family. This is a rich partnership and friendship.
Is there anything else you’d like to point out about this project?
Community-based participatory research is challenging but very rewarding. It is often underfunded, but you learn to be resourceful with what you have. It’s a fun way to practice “cost-efficient research.” Our model of using lay health workers is not novel—it is a very old technique that has been used in low- and middle-income countries for decades. We attempted to build a grassroots culturally appropriate mechanism for solving a public health problem. While the scale of our project was small, it can continue to grow. These lay health workers can discuss TB with work colleagues, among their congregation, or with friends and family. Their knowledge and advocacy reaches much farther and grips much stronger than my “American doctor voice” in an office visit. For a disease that can be devastating to the lungs, the abstract medicine of words and knowledge cures much more effectively than a stethoscope.