Studies of Knowledge and Attitudes
Dr. Colson (Program Director, Charles P. Felton National TB Center)
has a longstanding interest in LTBI, and the knowledge and attitudes
(K & A) associated with it. He investigated knowledge and attitudes
about tuberculosis and LTBI treatment in three different groups:
a) Participants in the Pathways to Completion prevention study
(described above) - 379 patients undergoing treatment for LTBI.
At baseline, participants showed substantial misconceptions about
TB, with sexual activity, kissing, and sharing dishes all viewed
as means of transmission. The mean number of knowledge items answered
correctly was 15.6 out of 24 at baseline and 18.3 out of 24 after
6 months of treatment (p<0.001). While overall knowledge scores
and many attitudes associated with adherence improved, some attitudinal
factors, such as self-efficacy and anticipated adherence, showed
declines. Substantial proportions of patients still felt shame about
TB and do not perceive appointments or treatment as priorities or
as beneficial after 6 months of treatment.
b) In the non-patient sample, Dr. Colson recruited 833 non-patients
in seven samples and examined their K & A regarding TB and LTBI.
All samples showed substantial misconceptions about transmission
of TB. The mean number of knowledge items answered correctly for
the non-patients was 6 out of 10 (60%). Subsequent analyses have
focused on exploring the relative importance of K & A in predicting
imagined adherence, using multiple logistic regression. Preliminary
results suggest that imagined adherence problems are associated
with having low self-efficacy, being in the gay men's sample, being
ashamed to have TB, and having less than a college degree.
c) Dr. Colson also investigated the impact of K & A and demographic
characteristics in health care providers initiating and completing
treatment for LTBI. Participants were 61% male, 75% African-American,
6% Latino, and 12% Asian. Median age was 34, 72% were foreign-born,
and 54% were recent TST converters. Many held misconceptions about
TB, including transmission through shared dishes (39%) and from
strangers rather than family members (22%). Approximately 15% did
not know the length of LTBI treatment or the increased risk faced
by HIV+ people. Superior knowledge scores were found in MDs and
RNs (p<.001), foreign-born patients (p=.017), recent converters
(p=.034), and younger patients (p=.011). The majority held positive
attitudes toward LTBI treatment, including believing in the importance
of treatment (80%) and in being able to avoid TB disease (78%).
Non-initiators were more likely to be nurses (p=.003) and to believe
they were not infected (p=.007). While no factors predicted treatment
completion, non-completers were more likely to feel that taking
medicines (p=.079) and keeping appointments (p=.054) were a problem.