Health communication issues related to latent tuberculosis infection treatment support for the foreign-born in Japan / 国際保健医療

ABSTRACT

Objective  To identify issues in health communication regarding treatment support for foreign-born who are diagnosed as latent tuberculosis infection (LTBI) in Japan, from the perspective of public health centers (PHCs).Methods  A self-administered survey was sent to 469 PHC, between June and July 2020. The survey asked closed and open-ended questions to tuberculosis (TB) program personnel on (1) their experiences of foreign-born patients who were eligible for LTBI treatment but did not start their treatment, and who started treatment but were lost to follow-up, and (2) health communication issues with foreign-born patients. Responses were summarized descriptively for close-ended questions, and analyzed qualitatively for open-ended question.Results  We obtained response from 307 PHCs, regarding 315 foreign-born patients. Twenty-five patients did not initiate, and 52 were lost to follow-up after initiating LTBI treatment. Of the 77 patients who either did not start treatment or were lost to follow-up, 45 apparently could hold everyday conversation in Japanese but had difficulties understanding technical terms, and 19 could not even exchange basic conversation, with PHC staff. Barriers to LTBI treatment initiation and completement, as perceived by PHC staff, included “lack of correct knowledge about TB and LTBI”, “different attitudes to health” and “economic difficulties”. Conclusion  Issues in health communication between PHC staff and foreign-born patients included not only a language barrier, but also the unconscious mind among PHC staff, which sought reasons for refusal or termination of LTBI treatment in patients. We argue that this mind is based on positivism, whereby health personnel consider themselves as the provider of “scientific knowledge” and that “lay persons” can act rationally once enlightened. However, PHC staff may need to reflect upon such position as the provider of scientific knowledge, but instead, learn from foreign-born patients about how they perceive health, TB or LTBI, to conduct better communication.