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Differences in Treatment-Seeking and Treatment-Adherence Factors for Tuberculosis in Armenian Versus Non-Armenian Populations Of Walden University ScholarWorks Walden Dissertations and Doctoral Studies Walden Dissertations and Doctoral Studies Collection 2016 Differences in Treatment-Seeking and Treatment- Adherence Factors for Tuberculosis in Armenian Versus Non-Armenian Populations of Los Angeles County Tanya Marie Ferguson Walden University Follow this and additional works at: https://scholarworks.waldenu.edu/dissertations Part of the Epidemiology Commons, and the Public Health Education and Promotion Commons This Dissertation is brought to you for free and open access by the Walden Dissertations and Doctoral Studies Collection at ScholarWorks. It has been accepted for inclusion in Walden Dissertations and Doctoral Studies by an authorized administrator of ScholarWorks. For more information, please contact [email protected]. Walden University College of Health Sciences This is to certify that the doctoral dissertation by Tanya Ferguson has been found to be complete and satisfactory in all respects, and that any and all revisions required by the review committee have been made. Review Committee Dr. Vasileios Margaritis, Committee Chairperson, Public Health Faculty Dr. Aimee Ferraro, Committee Member, Public Health Faculty Dr. Raymond Thron, University Reviewer, Public Health Faculty Chief Academic Officer Eric Riedel, Ph.D. Walden University 2016 Abstract Differences in Treatment-Seeking and Treatment-Adherence Factors for Tuberculosis in Armenian Versus Non-Armenian Populations of Los Angeles County by Tanya M. Ferguson MS, California State Polytechnic University, Pomona, 2006 BS, California State Polytechnic University, Pomona, 1996 Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Public Health, Health Sciences - Epidemiology Walden University May 2016 Abstract Tuberculosis (TB) is a deadly, yet curable, infectious disease that continues to be a global health threat. Armenia suffers from rising TB incidence and mortality rates. Armenians living in Los Angeles (LA) County, where TB incidence is higher than national averages, is the second largest Armenian community in the world; therefore implications are that many TB cases are attributed to this group. Using the social ecological model as a theoretical framework, this concurrent, mixed-methods study compared Armenians to non-Armenians in LA County about their knowledge of TB and perceived barriers to seeking and adhering to treatment. Bivariate chi-square analysis from online surveys of 55 Armenians and 72 non-Armenians revealed significant differences in their source of TB knowledge and compliance upon diagnosis. Multinomial logistic regression analysis was completed using the following significant predictor factors: classification, home remedy use, age, education, and primary household language. Parallel, in-depth interviews of 10 Armenians and 8 non-Armenians further corroborated that, although both populations were aware that TB exists, knowledge relating to TB mode of transmission, global incidence, and treatment options was generally lacking. However, the Armenian population was more eager to help others and urge seeking treatment when receiving a positive diagnosis, whereas non-Armenians expressed lack of willingness to physically assist patients. These findings have implications for positive social change, as they can inform the efforts of public health and health care entities in more effective disease management, resource allocation, and patient care. Such efforts should help decrease TB prevalence in the U. S. Armenian population and potentially Armenia. Differences in Treatment-Seeking and Treatment-Adherence Factors for Tuberculosis in Armenian Versus Non-Armenian Populations of Los Angeles County by Tanya M. Ferguson MS, California State Polytechnic University, Pomona, 2006 BS, California State Polytechnic University, Pomona, 1996 Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Public Health, Health Sciences - Epidemiology Walden University May 2016 Dedication This dissertation is dedicated to my mom, JoAnn. While she is no longer a physical presence in my life, her grace, virtue, and family values eternally resonate in all aspects of my life. All of my accomplishments are a reflection of her spirit and love. The importance of embracing our Armenian culture continues to be influential in my life, which served as an inspiration for this study. I love you (քեզ Սիրում եմ)․ Acknowledgments This has been a long and rewarding journey, with many people to thank for their contributions in helping me complete this dissertation and degree. My heartfelt gratitude extends to those have been integral to my continued success. Thank you for believing in me and instilling that anything is achievable. I would like to begin by thanking my committee members at Walden University, Dr. Vasileios Margaritis and Dr. Aimee Ferraro for their invaluable support and direction. As my committee chair, Dr. Margaritis was vital in pushing me and providing timely and important feedback. Thank you for your continued belief in me and constant encouragement even when I was beginning to lose hope. Thank you to Dr. Ferraro for your valuable input relating to methodology and social epidemiological considerations. I would like to express my utmost love and appreciation to my family and friends who provided infinite love and encouragement. My parents and brother in particular, provided unconditional support and reinforced the importance of persevering and completing this major life feat. I would also like to thank my closest and dearest friends for supporting me and laughing with me as I worked tirelessly at all hours of the night with the annoying glow from my computer resonating throughout the room. I would also like to express a special thank you to Arminé and Sossy for helping me with learning Armenian and executing the Armenian translations and interviews. The implementation and completion of this study would not be possible without you. Finally, I want to acknowledge and thank my special love, Chris. Thank you for your patience, understanding, and support. You are finally going to marry a doctor! Table of Contents Table of Contents ................................................................................................................. i List of Tables ..................................................................................................................... vi List of Figures ................................................................................................................... vii Chapter 1: Introduction to the Study ....................................................................................1 Introduction ....................................................................................................................1 Background ....................................................................................................................4 Disease History and Etiology.................................................................................. 4 Diagnosis, Therapy, and Prevention ....................................................................... 5 Susceptible Populations and Reported Barriers ...................................................... 8 Current State of TB in Armenia .............................................................................. 9 Current State of TB in the United States ................................................................ 9 Research Gap ........................................................................................................ 12 Problem Statement .......................................................................................................12 Purpose of the Study ....................................................................................................13 Research Questions and Hypotheses ...........................................................................14 Theoretical and Conceptual Framework ......................................................................15 Theoretical Framework ......................................................................................... 15 Conceptual Framework ......................................................................................... 16 Nature of the Study ......................................................................................................17 Operational Definitions ................................................................................................19 Assumptions, Scope, Delimitations and Limitations ...................................................22 i Assumptions .......................................................................................................... 22 Scope and Delimitations ....................................................................................... 22 Limitations ............................................................................................................ 23 Significance of the Study .............................................................................................25 Positive Social Change ......................................................................................... 25 Summary ......................................................................................................................26 Chapter 2: Literature Review .............................................................................................28
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