Nancy Holson
Charles P. Felton Nat TB Ctr
2238 5th Ave. 1st fl.
New York NY 10037
USA

Yael Hirsch-Moverman
Charles P. Felton Nat TB Ctr
2238 5th Ave. 1st fl.
New York NY 10037
USA

Beverly Diamond
Columbia University
 
Wafaa El-Sadr
Harlem Hospital
 
Sharon Mannheimer
Harlem Hospital
 
Purpose: There is growing interest in the use of stage-based interventions to effect behavior change.  Similar to Prochaska's Stage of Change model, the Precaution Adoption Process Model (PAPM; Weinstein 1998) is being used as the theoretical framework for an intervention to promote acceptance & completion of LTBI treatment (tx).

Methods: In an ongoing RCT promoting LTBI tx completion, patients (pts) were recruited from an inner city chest clinic and, using PAPM, were assessed at baseline for readiness to receive LTBI treatment.  Reliable scales were constructed of LTBI knowledge, perceived benefits, & perceived barriers items.  Pts in PAPM stages 1 Unaware, 2 Unengaged and 3 Deciding were categorized as Uncommitted to tx.  PAPM stages 5 Decided to Adopt and 6 Initiated were categorized as Committed to tx.  Pts' LTBI knowledge and perceived benefits & barriers to tx were assessed by these 2 levels of commitment.

Results: The 98 participants included 77% men, 47% Black, 32% African, 8% Latino, and 34% with history of homelessness. 67% were categorized as Committed to tx.  Overall knowledge scores at baseline were not significantly different.  Committed pts were less embarrassed about LTBI (36% vs. 59%, p=.031).  Committed pts perceived significantly more benefits to tx (3.4 vs. 3.1, p=.005).  Uncommitted pts perceived significantly more barriers to tx (2.3 vs. 2.0, p=.004).

Implications for Practice: While significant associations were not found between PAPM stage and knowledge, Committed patients were more likely to perceive benefits and less likely to perceive barriers than Uncommitted patients.  These preliminary results suggest that interventions to improve tx completion should focus more on addressing pt beliefs and less on improving knowledge.  Future analyses will examine the impact of these variables on tx completion.