Browsing by Author "Fisher, Dina"

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    Improving Infectious Tuberculosis Education and Counselling in Calgary for Patients who are Foreign-born and their Families
    (2022-07-26) Bedingfield, Nancy Joyce; King-Shier, Kathryn; Fisher, Dina; Lashewicz, Bonnie
    Patients and family members require comprehensive information and support to manage tuberculosis (TB). However, current TB education and counselling practices often fail to address family needs. This is particularly true in low TB incidence settings such as Canada, where linguistic and cultural dissonance between patients and providers is common. The objective of this research was to explore how TB health care workers (TB HCWs) and health systems leaders can focus education and counselling on the needs and preferences of patients and family members who are foreign-born experiencing advanced infectious TB in Calgary, Canada. The case study was conducted in three phases framed on the Social Ecological Model. In phase one, interviews were conducted with patients and family members to learn about their TB-related needs and experiences. In phase two, staff and physicians at the Calgary TB Clinic were interviewed to learn about their perceptions of barriers and supports to education and counselling for this group. In phase three, data from the first two phases were re-analyzed, relevant documents were reviewed, and health services and community leaders were interviewed to learn how health policy and social context influence education and counselling. Patients and family members described significant isolation associated with TB. Although patients and family members were satisfied with education and counselling, there was evidence that communication problems had occurred. TB HCWs reported numerous, multi-level barriers to providing education and counselling but found that continuity of care and clear information provided early reduced communication problems. Data from community leaders’ interviews and document review revealed that operational and public health priorities often took precedence over strengthening education and counselling. Leaders noted promising developments had recently increased attention to the needs of people who are foreign-born. Key recommendations for change include development of patient education and counselling guidelines, improved patient teaching materials, and offering a cultural patient navigator to families affected by advanced infectious TB. Adopting these changes could reduce fear and isolation in patients and family members; however, policy changes is required to realize the equity-enhancing potential of informing and supporting patients and family members affected by TB.
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    Is Universal Screening Necessary? Incidence of Tuberculosis among Tibetan Refugees Arriving in Calgary, Alberta
    (2016-12-29) Lim, Rachel; Jarand, Julie; Field, Stephen K.; Fisher, Dina
    Background. Canadian policy requires refugees with a history of tuberculosis (TB) or abnormal chest radiograph to be screened after arrival for TB. However, Tibetan refugees are indiscriminately screened, regardless of preimmigration assessment. We sought to determine the incidence of latent (LTBI) and active TB, as well as treatment-related outcomes and associations between preimmigration factors and TB infection among Tibetan refugees arriving in Calgary, Alberta. Design. Retrospective cohort study including Tibetan refugees arriving between 2014 and 2016. Associations between preimmigration factors and incidence of latent and active TB were determined using Chi-square tests. Results. Out of 180 subjects, 49 percent had LTBI. LTBI was more common in migrants 30 years of age or older (). Treatment initiation and completion rates were high at 90 percent and 76 percent, respectively. No associations between preimmigration factors and treatment completion were found. A case of active TB was detected and treated. Conclusion. Within this cohort, the case of active TB would have been detected through the usual postsurveillance process due to a history of TB and abnormal chest radiograph. Forty-nine percent had LTBI, compared to previously quoted rates of 97 percent. Tibetan refugees should be screened for TB in a similar manner to other refugees resettling in Canada.