Tuberculosis treatment for Mexican Americans living on the U.S.-Mexico border.

Key wordsTuberculosis, phenomenology, Mexican Americans, public healthAbstractPurpose: This study produced a rich description of the lived experiences of tuberculosis (TB) treatment among Mexican Americans living in the Lower Rio Grande Valley (LRGV) of Texas.Design: This qualitative study used phenomenological methodology, guided by Merleau-Ponty's philosophical framework, particularly his theories on mind-body influence, fabric of relationships, importance of culture, and equi- librium. A purposive sample was recruited through TB clinics in four south Texas border counties: Hidalgo, Cameron, Starr, and Willacy, which make up the LRGV. Interviews from 18 participants-5 women and 13 men-were con- ducted in the participant's preferred language. Interviews were analyzed for common themes as described by Cohen Kahn and Steeves.Findings: The majority of interviews were conducted in Spanish. Five themes were discovered: (a) day-to-day life during Directly Observed Therapy treat- ment, (b) signs and symptoms, (c) familismo, (d) living on the border, and (e) stigma.Conclusions: TB treatment can create a high level of patient burden. The participants in TB treatment in the LRGV on the Texas-Mexico border reported a high level of stigma. Due to this stigma, patients struggled to find a balance between exposure to stigma and the support from family that buoyed them through treatment.Clinical Relevance: The findings support the importance of addressing stigma and the resulting sense of isolation in patients being treated for TB, per- haps through bolstering support from family and healthcare providers, which is relevant for public health professionals working in regions with high rates of TB.Over 20 years ago, the World Health Organization (WHO) recommended that patients with active tuberculosis (TB) be monitored on a daily basis through the Directly Ob- served Therapy Short Course (DOTS) program to improve outcomes, decrease incidence, and decrease resistance to treatment (WHO, 2011). In DOTS, a trained healthcare representative watches a TB patient swallow each dose of TB medication, ensuring that the patient takes every dose of the prescribed antibiotics. TB is the only disease where this method of monitoring is practiced (Volmink & Garner, 2007).Since the implementation of DOTS, the incidence of TB has decreased; however, the United States has not reached its goal of TB elimination (Healthy People 2020, 2012). TB continues to burden the U.S.-Mexico border, with a rate 10 times the national rate (Texas Department of State Health Services, 2012). Several factors contribute to this higher incidence. First, there is a gradient increase of TB rates with the migratory flow from Mexico, a region of high TB rates, to the United States, a region of lower TB rates. Second, the population's low socioeconomic status frequently results in crowded housing and limited access to health care (Centers for Disease Control and Preven- tion, 2001). Finally, TB may spread more rapidly because of the difficulty of managing an infectious disease across an international border (de Cosio, Diaz-Apodaca, Ruiz- Holguin, Lara, & Castillo-Salgado, 2010).The Lower Rio Grande Valley (LRGV) is one of the re- gions on the U.S.-Mexico border that experiences high rates of TB. This region consists of Hidalgo, Cameron, Starr, and Willacy counties at the southernmost tip of Texas, bordered by the Gulf of Mexico to the east and the Rio Grande River to the south. The LRGV, like other areas along the U.S.-Mexico border, is a region where the mainstream U.S. culture interacts with the predom- inately Mexican culture (Richardson, 1999). Approxi- mately 90% of LRGV residents identify themselves as His- panic and predominately speak Spanish in their homes (U.S. Census Bureau, 2013). The region is also charac- terized by lower educational attainment, with one of the highest high school dropout rates in the state, and low- est per capita income (Mier, Flores, Robinson, & Millard, 2004). …