HEALTH EDUCATION IN A MULTICULTURAL SOCIETY: WHEN LANGUAGE BARRIER IS A PROBLEM IN TUBERCULOSIS DISEASE

Introduction:
Tuberculosis (TB) is a major preventable infectious cause of morbidity and mortality globally, posing a serious Public Health problem. Antibiotic treatments are currently available for latent TB infection (LTI) and TB disease. When these treatments are completed properly (with good adherence), they are very effective. It is therefore important that patients and their families understand the importance of complete treatment without interruption. Incomplete treatments threatening TB elimination and favor increased multidrug-resistant (MDR) TB, so it is very important to identify factors associated with adherence to treatment.

Objective:
The aim of this study is to identify epidemiological, clinical or social markers (risk factors) that make it possible to predict good or poor adherence to anti-TB treatment in the paediatric study population (0-18 years).

Methods:
We performed a retrospective observational study on the adherence to anti-TB medications in a cohort of pediatric patients followed-up from January 2011 to December 2013 at the Outpatient Clinic of Hospital xxx (Barcelona, Catalonia). Daily medication was self-administered or administered by parents in most cases. Variables analyzed: demographic data as age, sex, child's country of birth and family's country of origin, language barrier, and whether the index case had been identified or not and whether the index case was living with the patient and other clinical variables as treatment and toxicity. Statistical analyses were performed using SPSS software, version 20.0. Institutional review board approval was obtained.

Results:
A total of 261 children (134 females, 51.3%; mean/SD age: 7.2/4.8 years) were evaluated. Patients and their families were from 22 different countries. These countries were grouped into six geographic areas being from Spain (97 patients, 37.2%); Latin America (66; 25.3%); Morocco (59; 22.6%); Asia (19; 7.3%); Sub-Saharan Africa (6; 2.3%); Eastern Europe (3; 1.1%) and Unknown (11; 4.2%).
Two thirds of families (64.3%) were of foreign origin, but only 66 patients (25.3%) were born abroad. A language barrier was identified in 22 (8.4%) cases.
By logistic regression, only being born abroad (p=0.009), language barrier (p<0.0001) and development of toxicity (p=0.034) remained as significant risk factor for non-adherence.

Conclusion:
Our study has shown that the birth origin or country origin and language barrier may influence patients’ adherence. A proper communication and correct health education are not possible when language barrier exists. Greater cultural understanding is needed to design more specific interventions to improve Health Education, and so, the adherence in this group.
Strategies as training nurses, doctors or the other health care providers in communications skills, improving knowledge with a better understanding without the language barrier becomes an obstacle (i.e. written information in the patient's mother tongue).

References:
[1] Ailinger R.L., Martyn D., Lasus H. & Lima N. (2010) The effect of a cultural intervention on adherence to latent tuberculosis infection therapy in latino immigrants. Public Health Nursing 27, 115-120.
[2] M’Imunya J.M., Kredo T. & Volmink J. (2012) Patient education and counselling for promoting adherence to treatment for tuberculosis. Cochrane Database of Systematic Reviews 5, CD006591.