Two vicious circles contributing to a diagnostic delay for tuberculosis patients in Arkhangelsk.

Vladimir N Kuznetsov,Eva Johansson,Andrej O Mariandyshev,Andrej M Grjibovski,Gunnar A Bjune

doi:10.3402/ehtj.v7.24909

Abstract

SettingDelay in tuberculosis (TB) diagnosis increases the infectious pool in the community and the risk of development of resistance of mycobacteria, which results in an increased number of deaths.ObjectiveTo describe patients’ and doctors’ perceptions of diagnostic delay in TB patients in the Arkhangelsk region and to develop a substantive model to better understand the mechanisms of how these delays are linked to each other.DesignA grounded theory approach was used to study the phenomenon of diagnostic delay. Patients with TB diagnostic delay and doctors–phthisiatricians were interviewed.ResultsA model named ‘sickness trajectory in health-seeking behaviour among tuberculosis patients’ was developed and included two core categories describing two vicious circles of diagnostic delay in patients with TB: ‘limited awareness of the importance to contact the health system’ and ‘limited resources of the health system’ and the categories: ‘factors influencing health-seeking behaviour’ and ‘factors influencing the health system effectiveness’. Men were more likely to report patient delay, while women were more likely to report health system delay.ConclusionsTo involve people in early medical examinations, it is necessary to increase alertness on TB among patients and to improve health systems in the districts.

Highlights

Diagnostic delay is defined as the duration from the first appearance of symptoms to the initiation of treatment
A grounded theory (GT) [33] approach was used for data collection and analysis to generate new theory of factors contributing to mechanisms of DD on the path from symptoms onset to correct diagnosis of TB [33, 34]
The theory indicates two core categories: first ‘limited awareness of the importance to contact the health system’, which could be called ‘route delayed by patients’, and second ‘limited resources of the health system’, which could be called ‘route delayed by the health system’

Summary

Introduction

Diagnostic delay is defined as the duration from the first appearance of symptoms to the initiation of treatment It is a considerable problem in tuberculosis (TB), as it increases the infectious pool in the community (increases the time a patient stays infected) and the mortality rate [1]. HSD is associated with an initial visit to a low-level healthcare facility or a private practitioner (or traditional healer) without receiving a correct diagnosis [4, 5, 8, 9] Stigmatisation is another barrier that plays a negative role in health-seeking behaviour [10]. Patients with a resistant form of TB seem to be more likely to abuse alcohol [27, 28]

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