Background
Methods
Aim, design and setting
LTBI education screening and treatment program
TB and LTBI education program
LTBI screening
LTBI treatment
Community engagement and strategies
Strategies | Description of strategy | PHS |
---|---|---|
Strategy 1:Invitation through mail and social media | The local community of PHS 1 lacked regular social gatherings, for example a church, which could be used as approaching strategy. Therefore, the PHS 1 project team approached the target group through individual invitation -consisting of a flyer in Tigrinya- by mail, for which addresses of the target group where obtained by the PHS through the municipality. Additionally, the key figure posted an invitation on a Facebook group for Eritreans in that city (approximately 120 members). LTBI education: organized twice, during a week night, at two different local community centres LTBI screening: approximately 1 week after education, on appointment, at the PHS One key figure of PHS 3 promoted the education session in a WhatsApp group of the church. (Additional to strategy 2) | 1,3 |
Strategy 2:Face-to-face promotion | The key figure of PHS 1 asked other key figures -working for other PHS departments- to spread the invitation and promote participation within their network during face-to-face contacts. (Additional to strategy 1) The project team of PHS 3 identified various places - Dutch language classes, libraries, the church, and the gym- where Eritreans regularly gather. At those places, key figures approached individuals to promote the upcoming education session verbally and by handing out flyers with invitations. LTBI education: organized twice, during week night, at a local community centre LTBI screening: organized three times, approximately 1 week after the education, during week day, at the PHS | 1,3 |
Strategy 3:Dutch language classes | PHS 1 and 2 used Dutch language classes (PHS 1 at one school, PHS 2 at two schools) to reach Eritrean migrants. The project team approached the school management to discuss the possibility to organize education sessions at the school. After agreement, a teacher (Strategy 3.1 - PHS 1) or the key figures (Strategy 3.2 - PHS 2) approached students to come to the education session and handed out flyers. One school handed out flyers and displayed posters in the school (Strategy 3.3 - PHS 2) to promote the education session. LTBI education: organized three times, at two different schools LTBI screening: approximately 1 week after the education session, once during week night at the PHS, twice on appointment during week day at the PHS | 1,2 |
Strategy 4:Group housing | The key figures of PHS 2 (Strategy 4.1 and 4.2) and the TB nurse of PHS 4 (Strategy 4.3) utilized existing contacts with resident(s) of group housings. Group housings are temporary residents with up to 35 young adult females or males, who transferred from an asylum seeker centre and are waiting individual housing to come available. In consultation with the residents, the key figures organized an education session in a community space of the houses. LTBI education: during a week night, at the house LTBI screening: organized approximately 1 week after the education, during a week day at the house (strategy 4.3 (PHS 4)) or on appointment at the PHS (strategy 4.1 and 4.2 (PHS 2)) | 2,4 |
Strategy 5:Sports club | The TB nurse of PHS 2 approached an Eritrean soccer coach who organizes weekly soccer trainings for Eritrean migrants. In consultation with the coach, the TB nurse organized an education session after soccer training. LTBI education: during a week night, after training at the sport club LTBI screening: organized approximately 1 week after the education, during a week night, at the PHS | 2 |
Strategy 6:Eritrean church | Strategy 6.1: One PHS4 key figure was a member of the church board of trustees and obtained their consent to promote the LTBI education and screening after a church service. Interested church members were asked to sign up for the screening. Registered members received an invitation by mail. Those who did not show-up for the first screening appointment were invited a second time. Strategy 6.2: The key figure of PHS 4 brought the project researcher (IS) in contact with a priest of a church in the PHS 5 region. The priest allowed the team to promote the LTBI education and screening after a church service. After the promotion, church members were handed-out invitations with date and time of screening. LTBI education: promotion of the intervention organized after the church service LTBI screening: organized 1 week (PHS 4) / 2 weeks (PHS 5) after education session on appointment at the PHS We arranged for church members who did not live in the PHS 4 or PHS 5 region to visit the PHS in their own region. | 4,5 |
Quantitative data collection and analysis
Qualitative data collection and analyses
Group interviews with project teams (n = 4)a | |
Participation | The PHS project coordinator, the key figure(s), additional PHS staff (such as the TB physician, TB nurse, Medical Technical Assistant). |
Time | Approximately 1 h |
Location | At the PHS office |
Informed consent | A-priori audio-taped verbal consent |
Communication | Dutch |
Transcript | Verbatim in Dutch (by IS) |
Incentive | None |
Group interviews with Eritrean participants (n = 5) | |
Participation | Group interviews, each consisting of 4 to 6 participants, took place immediately following the LTBI screening |
Time | Between 30 and 45 min |
Location | At the PHS, in a separate room to ensure privacy |
Informed consent | Written a-priori informed consent |
Communication | Tigrinya |
Transcript | Verbatim translated from Tigrinya in English (by DTH) |
Incentive | None (beverages were provided) |
Individual interviews with Eritrean participants diagnosed with LTBI (n = 10) | |
Participation | TB nurses asked Eritrean clients on LTBI treatment for consent to be approached by phone for an invitation to participate in an individual interview and to set an appointment if willing to participate. |
Time | Between 15 and 30 min |
Location | Location to the client’s convenience |
Informed consent | Written a-priori informed consent |
Communication | Tigrinya |
Transcript | Verbatim translated from Tigrinya in English (by DTH) |
Incentive | A 10-euro voucher |
Results
Quantitative results
PHS | Strategies | Numbers envisioned to reach | Participated in LTBI education | Received LTBI screening | |
---|---|---|---|---|---|
n | n (% of n envisioned to reach) | n (% of n LTBI education) | (% of n envisioned to reach) | ||
Total | 904 | 401 (44%) | 257 (64%) | (28%) | |
4 | Strategy 4.3: Female group house | 35 | 25 (71%) | 31 (124%)a | (89%) |
3 | Strategy 2.1: Face to face promotion | 47 | 30 (64%) | 62 (124%)a | (84%) |
Strategy 2.2: Face to face promotion | 27 | 20 (74%) | |||
2 | Strategy 5: Male football team | 20 | 15 (75%) | 10 (67%) | (50%) |
2 | Strategy 4.1: Female group house | 20 | 12 (60%) | 9 (75%) | (45%) |
4 | Strategy 6.1: Eritrean church | 200 | 65+ (33%) b,c | 70 (108%) | (35%) |
2 | Strategy 3.2: Dutch language classes | 50 | 30 (60%) | 16 (53%) | (32%) |
1 | Strategy 1: Invitation through mail and social media | 175 | 44 (25%) | 32 (73%) | (18%) |
1 | Strategy 3.1: Dutch language classes | 20 | 12 (60%) | 3 (25%) | (15%) |
2 | Strategy 3.3: Dutch language classes | 60 | 8 (13%) | 7 (88%) | (12%) |
2 | Strategy 4.2: Male group house | 50 | 30 (60%) | 5 (17%) | (10%) |
5 | Strategy 6.2: Eritrean church | 200 | 110 (55%)d | 11 (10%) | (6%) |
Qualitative results
Overall experience with the program
Eritrean respondent: “I think it is a huge support for us to get it for free! How would we have paid for this? I don't know if these medicines exist in our country? So, I consider myself lucky to get this opportunity.” [Individual interview 1]
Program facilitators
Eritrean respondent: “People keep saying they are healthy, but we all said the same thing. I never had any complaints; I was not coughing. Still it was sleeping in my body. Now we can prevent it from developing into the TB disease. Therefore, we should share our experience with those who didn’t come, if you could organize a health education seminar again.” [Individual interview 7]
Key figure 2: “They need time to really understand the purpose and importance. ( … ) So, several announcements and several registration opportunities. After the first time, they will share their experience [with LTBI screening] among each other. Then organize a second time. Eventually, it will gain publicity and then they will cooperate.” [Group interview PHS 4]
Key figure: “The young generation do not trust the key figures who have been in the Netherlands for 20 years. They [young generation] think that certain things happen to them personally because of the key figures, because they are the translators and are always around procedures such as housing.” [Group interview PHS 1]
Progra1m barriers
TB nurse: “The men said: ‘I thought you guys came to tell us something about TB related to our housing condition. If not, why would I come? I don’t care if I have TB, anything better than living in this house’.” [Group interview PHS 2]
Eritrean respondent: “I participated only because I was at home. If I had a trip somewhere, I would not have come. I always thought I was healthy, and the education was not important. ( … ) I only found out that I had LTBI because I did the blood test. So, I learned a lesson from my situation, and I try to explain it to others.” [Individual interview 6]
Eritrean participant: “They said this is a pilot project to do a blood test for TB. What do you say about the fact that they are testing it on us? They did not test it on the Arab people? What if the virus stays in the needle, they are using to test this new method and it infects us? It is normal to be sceptical about this.” [Group interview 3]