Canadian tuberculosis health care workers’ perspectives on education and counselling for patients and family members who are born outside of Canada

Figures & data

Figure 1. Routine care for patients and family members 8–12 weeks post diagnosis.

^¶Initial information consists of household contact age and current symptoms. *Less than 5 years of age or profoundly immunocompromised. ^ɸDetailed information consists of age, current symptoms, TB history, and overall health history. ^±Nursing appointments for medication five days per week × 8 weeks. Frequency often reduced after 8 weeks. ^§Consists of two nursing appointments 48–72 hours apart.

Table 1. Demographic characteristics of Calgary health care workers participating in 2020 data collection^a.

Total participants	24
Professional role
Practical or registered nurse	13 (54%)
Physician	4 (17%)
Clerical/allied health professional	7 (29%)
Median age (years)	38 (IQR 33–45)
Median number of years employed at Calgary TB Clinic	3 (IQR 1.5–7.5)
Highest level of education
Diploma	3 (13%)
Undergraduate degree	14 (58%)
Graduate degree	8 (33%)

^a Data collection consisted of semi-structured interviews and field notes collected between April and July 2020.

Table 2. Health care worker perceptions of barriers and facilitators to advanced infectious TB education and counselling with patients and family members born outside of Canada.

Social ecological level	Identified barrier	Facilitative change to education and counselling practice
Intrapersonal	Patient and family misperceptions about TB High levels of patient and family member stress related to demands of TB isolation and treatment Disconnect between education and counselling practice and patient and family members’ expectations based on experiences outside of Canada
Interpersonal	Time required to understand unique family structures and communication patterns
Institutional	Too much information at initial appointments Institutional rules regarding patient confidentiality (inhibited communication with family members) Limited clinic operating hours Limited time during appointments for education and counselling Lack of HCW confidence regarding anti-TB stigma counselling	Increased consistency of care Providing information in smaller amounts (e.g. preparation for first appointment) Repetition of key concepts Multilingual staff Updated multilingual teaching materials Family meetings between patients, family members, and HCWs
Structural	Low paid and insecure work for people born outside of Canada (inhibited phone communication and appointment attendance) Pervasive language barriers with HCWs