Dissertations & Theses (Open Access)

Date of Award

Fall 12-2018

Degree Name

Doctor of Public Health (DrPH)


Melissa A Valerio, Phd

Second Advisor

Paula E Stigler Granados, Phd

Third Advisor

John Herbold, Dvm, Mph, Phd


An estimated 300,000 people in the U.S. are living with Chagas Disease (CD), many of whom may not yet know they are infected. Approximately 20% to 30% of individuals with CD are expected to develop clinical symptoms that may manifest as heart disease and result in death if left untreated. The prevalence of CD in humans is not well understood. Given its asymptomatic manifestation and the rarity in cases seen by physicians in general, CD may be under-recognized by physicians.

The purpose of this research was to explore the understanding and knowledge of CD in Texas HCP populations (cardiologists, infectious disease specialists, and general/ family practice providers) and identify provider-based education and practice recommendations to reduce the prevalence of undiagnosed CD.

Texas quarterly Inpatient Public Use Data Files (IPUDF) for 2013 to 2016 were used to identify ICD heart-related missed CD diagnosis and CD diagnosis and map the cases. Counties with a high burden of heart-related diagnosis were indicative areas with CD diagnosis, as shown by the ICD codes and by the TDSHS CD-reported cases. Heart-related diagnosis and age demographics indicate the possibility of missed CD diagnosis throughout the state.

Self- administered online knowledge, attitudes, and practice (KAP) questionnaires were used to quantify knowledge deficits by physician specialty (n= 43): family or general practice (n= 21); infectious disease (n= 19); and cardiology (n= 3). ID specialists had a greater grasp on the nuances of CD and were more confident than family providers in recognizing risk factors and the vector and were more knowledgeable overall.

Key informant (KI) telephone interviews were conducted (n= 13) among infectious disease specialists (n= 8), cardiologists (n= 4), and one family physician to explore barriers and recommendations to improve awareness and knowledge. Training and experience, according to the KI, were essential in shaping physicians’ understanding of CD in Texas. Specific physician recommendations to enhance awareness and improve knowledge on CD in Texas include: 1) engage patients and physician leadership; 2) increase surveillance to better understand prevalence; 3) improve access to physician resources and how materials on CD are disseminated; and 4) improving and updating physician resources