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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.