New York City focuses on latent TB infection
New York City focuses on latent TB infection
Market research defines a new campaign
Starting on World TB Day in March, TB controllers in New York City began hawking a new product: the treatment of latent TB infection. One carefully tailored radio spot tells about "the sleeping germ" another urges listeners to consider whether they might need to be evaluated and treated. The spots began running on March 24 on radio stations that target certain ethnic communities.
The media mini-events mark the public debut of the city’s new multifaceted approach to what’s become a multifaceted problem, explains Paula Fujiwara, MD, head of the city’s TB control division. "In the next few years, we’re going to have to practice TB control in many different ways and run many different campaigns at once," she says. In a city as diverse as hers, where most of the TB cases are foreign-born, the days of monolithic, one-size-fits-all problems and treatments are over, she adds. "This isn’t like the days when TB here was driven largely by HIV. That was comparatively easy work. Now, we’re having to get a lot more specific."
In that spirit, the city has lifted a page or two from market research. Starting last July, the TB control division began conducting focus groups among the five immigrant groups where the most TB morbidity in the city is found — namely, the Haitian, Chinese, Ecuadorean, and Dominican communities. The fifth community, Puerto Rican, is not technically classified as immigrant but still possess its own language and culture, Fujiwara points out.
Focus groups consist of about 45 people. Incentives to take part include transportation tokens, a meal, and a modest cash award. A professional "facilitator" leads group members through a series of questions designed to get at attitudes and beliefs about TB and TB infection, Fujiwara says.
Participants talk about their understanding of TB and TB infection; they’re asked whether they know anyone with TB; they talk about the relationship, if any, they believe the health department has with immigration authorities. Would, for example, the health department report them to immigration?
Findings from the focus groups, though preliminary, suggest that the different communities have strikingly varied beliefs and attitudes on such subjects.
Ecuadoreans, for example, seem to have the most difficulty understanding the idea of a BCG vaccination, while members of the other communities harbor deep suspicions about the health department’s links to the Immigration and Naturalization Service.
Doctors targeted, too
In addition to exploring beliefs, the groups discuss which media they prefer for messages about health care, Fujiwara says. The Chinese like getting such information in a newspaper; Haitians prefer hearing it from a trusted friend; Ecuadoreans are most open to getting it in church.
"The point is, we’re not going to print up one poster and translate it into five different languages," in part because not everyone likes posters, she says.
A second prong of the marketing campaign will take aim at key private providers who serve the five communities. "We can do all the community education we want, but if we miss the pro viders, it’s not going to work," Fujiwara explains. "You tell someone they need treatment for latent TB infection, and they head to their private provider for a second opinion. If the message they get there is, Forget about it, you’ve had a BCG vaccination,’ then nothing we do will work."
Thus, a second series of focus groups has been convened to try to determine what providers see as barriers to providing treatment for latent infection. In those groups, as in the others, facilitators ask physicians in what form they prefer getting material — in a handout or on a Web site, for instance.
Make it personal
Visiting offices of doctors who’ve been identified as key figures in their communities or, conversely, as skeptics who steer patients away from screening and treatment for latent TB infection, is another crucial part of the campaign.
"Going out to these peoples’ offices and establishing a relationship with them is going to be crucial to changing their practices," explains Fujiwara. "We can throw written material at them all day long without changing their minds. What we need to have happen is for docs in our outreach community to go to them and say, Hey, have you thought about doing it this way?’"
The marketing campaign will be an ongoing effort, not a one-shot intervention, she notes. Once materials specific to the needs of each community are developed, they’ll be tested on focus groups again and retooled according to feedback. The campaign and the materials will be developed in-house. Outside experts have been engaged to run the focus groups.
"The point here is that this is a measured attempt to do something, not just a blanket approach," Fujiwara says. "We’re trying to do this in an informed way, with messages that are based, not just on our assumptions about what we believe to be true, but on what we have found."
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