Influences of the Homeless Shelter Environment on the Personal Experience of Tuberculosis Disease During a Large Outbreak in Atlanta, Georgia Public
Connors, William (2017)
Abstract
INTRODUCTION: Homeless persons represent a key high-risk
population for tuberculosis (TB) among whom TB disease has outsized
public health implications. Little is known about how homeless
persons experience TB illness and prevention and control measures
implemented in response to a TB outbreak. This qualitative study
aimed to explore homeless persons' TB disease experiences in the
context of a large TB outbreak involving overnight homeless
shelters in Atlanta, Georgia.
METHODS: In-depth interviews were conducted with a
purposive sample of homeless persons with active TB disease
residing in Atlanta during the shelter outbreak. Key themes were
identified through analysis of coded data. Following interviews a
demographic questionnaire was completed and participants' medical
records were reviewed.
RESULTS: Ten participants (9 male, 1 female,
all African American and US born) with baseline high-risk profiles
for TB were interviewed. Nine participants had sputum culture
positive disease, five (56%) had the TB strain associated with the
ongoing homeless shelter outbreak and four had distinct TB strains.
Interviews contained five pervasive themes: (i) health and
behavioral impact of the homeless shelter context, (ii) influence
of homelessness on disease experience, (iii) role of acute health
care services, (iv) experiences with shelter-based interventions
implemented in response to the TB outbreak, and (v) sources of TB
knowledge and health literacy. The central theme to emerge from
analysis was that stressful social environments of homeless
shelters shape illness experiences, healthcare-seeking behaviors,
and limit the influence of shelter-based prevention and control
measures implemented in response to a TB outbreak.
CONCLUSIONS: Homeless shelter related stress may have important implications for the prevention and control of TB outbreaks in this setting, hindering case finding and supporting a model of supplemental TB education and latent tuberculosis infection testing services at proximal community venues. Systematic qualitative assessments in the context of evolving public health responses may provide novel insights that can strengthen TB elimination efforts.
Table of Contents
CHAPTER 1 : Introduction
1.1 Introduction and rationale
Figure 1: Tuberculosis incidence among US- & foreign-born persons, by yr. - US, 2000-15
1.2 Problem statement
1.3 Purpose statement
1.4 Research questions
1.5 Significance statement
1.6 Definition of terms
CHAPTER 2 : Literature Review
2.1 Epidemiology of tuberculosis among the United States homeless population
Figure 2: Tuberculosis cases reported among homeless persons - US, 1993-2015
Figure 3: Point-in-time national overall homelessness rate - US, 2007-15
2.2 Qualitative research on the homeless health experience
2.2.1 Healthcare system experiences & their influence on health seeking behaviors
2.2.2 Qualitative research on the homeless health experience specific to TB
CHAPTER 3 : Manuscript
Table 1: Participant demographics and route to TB diagnosis
Table 2: Participant tuberculosis profile and diagnostics
Figure 1: Typical case representing patterns of healthcare engagement
CHAPTER 4 : Recommendations
REFERENCES
APPENDIX 1: Interview Guide
APPENDIX 2: Post-interview Questionnaire
About this Master's Thesis
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