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Ramadan and Culturally Competent Care

Strengthening Tuberculosis Protections for Recently Resettled Muslim Refugees

Stockbridge, Erica L. PhD; Kabani, Faizan A. RDH, PhD; Gallups, Jeremy S. RN; Miller, Thaddeus L. DrPH, MPH

Journal of Public Health Management and Practice: November 28, 2018 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/PHH.0000000000000893
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To improve latent tuberculosis infection treatment completion rates, Tarrant County Public Health began providing after-dusk home delivery of a 12-dose latent tuberculosis infection regimen of weekly rifapentine plus isoniazid administered via directly observed preventive therapy during Ramadan, a month of prayer and daytime fasting observed by Muslims. In unadjusted difference-in-difference logistic regression analyses (n = 148), Muslim patients had lower treatment completion rates than non-Muslim patients during Ramadan prior to program implementation (68.8% vs 95.4%), whereas rates were comparable postimplementation (95.7% vs 96.4%; difference-in-difference P = .011). Similar results were found after adjusting for age and gender (pre: 71.4% vs 94.8%; post: 95.5% vs 96.3%; P = .032). These findings provide evidence of the need for and effectiveness of programmatic innovations tailored to the varying cultural norms of the widely diverse populations served by public health authorities and suggest that culturally competent clinical care may advance population health goals.

Department of Health Behavior and Health Systems, School of Public Health (Drs Stockbridge and Miller and Mr Gallups) and Institute for Patient Safety (Dr Stockbridge), University of North Texas Health Science Center, Fort Worth, Texas; Department of Advanced Health Analytics and Solutions, Magellan Health, Inc, Scottsdale, Arizona (Dr Stockbridge); and Caruth School of Dental Hygiene, College of Dentistry, Texas A&M University, Dallas, Texas (Dr Kabani).

Correspondence: Erica L. Stockbridge, PhD, Department of Health Behavior and Health Systems, University of North Texas Health Science Center School of Public Health, 3500 Camp Bowie Blvd, Fort Worth, TX, 76107 (...).

The 1115 Healthcare Transformation Waiver program funded the development and implementation of Tarrant County Public Health's current model of care for latent tuberculosis infection treatment, and the Ramadan after-hours delivery program described herein was a continuous quality improvement component of that project.

The authors acknowledge the work of Tarrant County Public Health and its Tuberculosis Elimination Division staff, especially Abram Oliver, MS (Outreach Supervisor); Margaret Collazo, LVN; Jason McGhee, LVN; Thera Savala, LVN; and Bhola Khatri, CSA. This article is dedicated to the memory of Bhola Khatri, who played a key role in executing the Ramadan quality improvement program by performing much of the after-hours delivery described herein.

The authors have no potential conflicts of interest to report.

The findings and conclusions described in this report are those of the authors and do not necessarily represent the positions of the institutions or companies with which the authors are affiliated.

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