A Participatory Approach to Develop and Evaluate Tuberculosis Educational Products for Spanish-Speaking Foreign-born Persons

Background: Spanish-speaking foreign born persons comprise approximately 35% of U.S. tuberculosis (TB) cases annually. Responding to a lack of educational materials tailored to this population, the SNTC employed participatory methodologies to develop and evaluate a fotonovela to facilitate awareness of TB services and processes of care in the US. Methods: Project staff convened a Project Advisory Committee comprised of TB program staff, health educators, and county extension staff to develop and validate the storyline and script. This was followed by an extensive formative evaluation, involving focus group discussions with foreign-born Hispanic persons diagnosed with TB and those without a prior diagnosis; intercept interviews based on the Maguire's Communication Matrix with persons seeking services at a community organization where the product was made available; and in-depth interviews with TB healthcare professionals. Results: In general, participants found the fotonovela easy to understand, culturally sensitive, relevant, credible, and persuasive. Most intercept interview participants who retrieved the fotonovela recalled key messages and reported gaining knowledge, sharing and discussing information, and positive intentions towards TB testing and treatment. Evaluation results have been used to plan diverse changes in the format, content, and dissemination of the fotonovela. Actionable items included: developing chapter 1 as stand-alone material (format); adding Quick Facts to chapters and providing a better explanation of the BCG vaccine (content); and developing an English version and designing an attractive display (dissemination). Conclusions: This participatory approach incorporated the perspective of various stakeholders and provided multiple levels of evidence to further guide product development and marketing.