Journeys to tuberculosis treatment: a qualitative study of patients, families and communities in Jogjakarta, Indonesia

N Rintiswati,Suharna Suharna,Y Subronto,Y Mahendradhata,Cm Varkevisser,Mj Van Der Werf,Susilawati Susilawati,Purwanta Purwanta

doi:10.1186/1471-2458-9-158

Abstract

BackgroundMany tuberculosis (TB) patients in Indonesia are diagnosed late. We seek to document patient journeys toward TB diagnosis and treatment and factors that influence health care seeking behavior.MethodsTB patients in Jogjakarta municipality (urban) and Kulon Progo district (rural) were recruited from health care facilities participating in the DOTS strategy and health care facilities not participating in the DOTS strategy, using purposive sampling methods. Data were collected through in-depth interviews with TB patients and members of their family and through Focus Group Discussions (FGD) with community members.ResultsIn total, 67 TB patients and 22 family members were interviewed and 6 FGDs were performed. According to their care seeking behavior patients were categorized into National TB program's (NTP) dream cases (18%), 'slow-but-sure patients' (34%), 'shopaholics' (45%), and the NTP's nightmare case (3%). Care seeking behavior patterns did not seem to be influenced by gender, place of residence and educational level. Factors that influenced care seeking behavior include income and advice from household members or friends. Family members based their recommendation on previous experience and affordability. FGD results suggest that the majority of people in the urban area preferred the hospital or chest clinic for diagnosis and treatment of TB whereas in the rural area private practitioners were preferred. Knowledge about TB treatment being free of charge was better in the urban area. Many community members from the rural area doubted whether TB treatment would be available free of charge.ConclusionMost TB patients took over a month to reach a DOTS facility after symptoms appeared and had consulted a number of providers. Their income and advice from household members and friends were factors that influenced their care seeking behavior most.

Highlights

Many tuberculosis (TB) patients in Indonesia are diagnosed late
Every individual diagnosed and recorded as TB patient by a public or private health care provider or a traditional healer was eligible for inclusion in the study
TB patient perspective TB patient characteristics We interviewed 67 patients, 50 from Jogjakarta municipality, and 17 from Kulon Progo (Table 2)

Summary

Introduction

We seek to document patient journeys toward TB diagnosis and treatment and factors that influence health care seeking behavior. Indonesia's National TB Control Programme (NTP) faces many challenges despite its impressive performance in reaching the international targets for case detection (>70%) and treatment success (>85%) in 2006 [1]. One key challenge for attaining these targets is early diagnosis and treatment of TB patients, which is considered to be the foundation of TB control. Private practitioners (PPs) and traditional healers were not yet formally incorporated into the DOTS strategy at the time of the study. PPs diagnose TB based on clinical symptoms, chest X-ray or smear microscopy, traditional healers diagnose TB on symptoms. Some of the PPs refer their patients to DOTS services for diagnosis and treatment, albeit not systematically [7]. There are no institutional arrangements for DOTS yet for these care providers and patients have to pay for consultation and treatment

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