Testing Latent TB Infection Messages Using Audience Research Surveys

Theoretical Background and research questions/hypothesis:

Using familiar terms can help health messages reach audiences more effectively by improving understanding. Testing messages and materials during development reveals what terms are most familiar and understandable to the audience.

CDC creates communication and education materials to raise awareness of latent tuberculosis (TB) infection. In 2020, a qualitative formative assessment found that using terminology other than “latent TB infection”, like “inactive TB”, made messages about latent TB infection more understandable to intended audiences. To build on these qualitative findings, terms were tested in a large audience research survey.

Methods:

CDC analyzed data from the 2022 Porter Novelli Estilos survey, an online survey of adult Hispanic consumers in the United States. Quotas are used for age, language, acculturation level, region, gender, and heritage to total 1,000 respondents. The survey is available in English and Spanish. The data are weighted to match U.S. Census American Community Survey (ACS) proportions and by language spoken at home, cultural self-identification, and use of Spanish language media. Respondents were asked, “Sometimes tuberculosis (TB) bacteria can live in your body for years without making you sick. What term would you use to describe this condition? Select one answer.” Weighted proportions of select TB terms were calculated by respondent language and health literacy.

Results:

Overall, the most frequently preferred terms were “inactive TB” (16%) and “dormant TB” (15%), followed by “sleeping TB” (9%), “latent TB infection” (5%), and “TB infection” (4%), while 51% of respondents selected “not sure”. Among those who reported speaking only Spanish at home, the most preferable term was “sleeping TB,” among those who reported speaking Spanish mostly, or Spanish and English equally, the preferred term was “inactive TB,” and among those who reported speaking English mostly or only at home, “dormant TB” was the most preferred option. Similarly, among those who completed the survey in Spanish the preferred term was “inactive TB” while those who completed it in English preferred “dormant TB.” In response to the item, “I have difficulty understanding a lot of the health information that I read,” among those who selected “strongly disagree,” the preferred term was “inactive TB,” for those who selected “somewhat disagree” or “neither agree nor disagree” the preferred term was “dormant TB,” those who selected “somewhat agree” equally chose “sleeping TB” and “dormant TB,” while whose who selected “strongly agree” preferred “sleeping TB.”

Conclusions:

Estilos survey participants who expressed a preference did not find the term “latent TB infection” preferable to describe the condition, and preferred “inactive TB” or “dormant TB”. Additionally, results suggest that individuals who speak different languages or have different health literacy levels may prefer different terminology. Future work to assess reasons behind preferred terminology, testing with more audiences, and in additional languages can help guide education and communications efforts.

Implications for research and/or practice:

The Estilos survey allowed for message testing with a large sample of individuals. CDC’s Think. Test. Treat TB campaign uses “inactive TB” alongside the medical term “latent TB infection” to enhance understanding.