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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.
RESUMO
@#Objective: This study aims to compare the epidemiology of notifications of latent tuberculosis infection (LTBI) among Japan-born and foreign-born children in Japan between 2010 and 2020, and to assess the language used during LTBI case interviews with parents or caregivers of foreign-born children with LTBI during 2019. Methods: Our study consisted of two parts: (1) an analysis of national data from the Japan Tuberculosis Surveillance (JTBS) system on the epidemiology of LTBI among Japan-born and foreign-born children in Japan and (2) a survey of staff at public health centres that had registered at least one foreign-born child aged <=14 years with LTBI. Data were extracted from the JTBS system for all children aged <=14 years who were newly notified as having LTBI between 2010 and 2020, and analysed to determine trends, characteristics and treatment outcomes. Staff at relevant public health centres completed a self-administered survey. Results: A total of 7160 Japan-born and 320 foreign-born children were notified as having LTBI between 2010 and 2020. Compared with Japan-born children, foreign-born children notified as having LTBI were more likely to be older, have their mother or sibling as their source of infection and have LTBI detected via a routine school health check. At case interviews, the use of language interpretation services was limited, even when both parents were non-Japanese. No interview was directly conducted with children themselves, not even with school-aged children. Discussion: Foreign-born children and their parents may be unfamiliar with the system of testing for TB infection and the diagnosis of LTBI in Japan in school settings. Public health centres are required to provide education to patients and their families and care that takes into account cultural and linguistic differences. However, the provision of language support during case interviews may need strengthening.
