Overcoming cultural and linguistic barriers in TB services

As part of the RCN TB Nurses Travel and Research Award, Rebecca Welfare, formerly TB Nurse Consultant, Centre for Infections, Health Protection Agency, travelled to Seattle, USA in May to attend the Community House Calls Program at Harborview Medical Center. She writes.

Addressing inequalities

In the USA, like the UK, TB disproportionately affects certain ethnic minority communities born overseas and within the USA. Recent reports in both the USA and UK have demonstrated the need to address inequalities in health service provision by providing culturally and linguistically appropriate services that meet the needs of the community they serve. This cannot be more evident than in TB services in the UK, where approximately 70 per cent of all cases are non-UK born and where cultural and linguistic barriers pose a challenge to both provider and patient in the clinical setting.

The programme

The Community House Calls Program at Harborview Medical Center in Seattle has over 14 years’ experience in employing medical anthropological principles in the health care setting. Based on the community health care worker model, the program currently consists of seven bilingual, bicultural caseworkers who perform a pivotal role mediating between acute and primary health care services and the community setting, providing social and cultural case management in liaison with medical and allied professionals.

Managed by a nurse supervisor, department manager and medical director, the cultural case workers have first-hand experience of resettlement in the USA and have strong and well established links with their respective communities. As case managers, the cultural caseworkers act as advocates, mediators, and interpreters for non-English speaking populations and for those who do not speak English very well across the hospital and community setting. They provide not only an individualised approach to case management, but also identify and address wider community issues that impact on health. In addition, their presence in the health care setting provides a means of increasing clinicians’ awareness of cultural and linguistic issues, while also challenging cultural assumptions and misconceptions, which could potentially affect the quality of care delivered.

This cultural caseworker model at Community House Calls was piloted by Seattle and King County Public Health Department TB service between 1999 and 2001, where the socio-cultural and community based approach to care was found to improve treatment completion rates and the quality of patient care for individuals from specific ethnic minority groups. The model has since been replicated in other State TB programmes throughout the USA.

Applicable to the UK?

The cultural caseworker model could be developed and adapted for use in TB and allied health services in the UK setting, particularly in areas where there is a high prevalence of non-English or limited English speaking populations and where a socio-cultural case management approach is required.

For more information, contact me on email: rebecca.welfare@googlemail.com