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Socio-cultural Influences on Patient Delays in Seeking Treatment for TB Symptoms: A Qualitative Study on Rural TB Patients in Andhra Pradesh
Patient delays in seeking treatment, non-adherence to anti-TB treatment, drug resistant TB, and stigma are the most serious barriers to the control and elimination of TB in large number of developing countries, India is no exception. Currently, in India passive case findings approaches for TB diagnosis are applied. The success of the passive case findings approach largely depends on the patients' ability to recognize the early symptoms of TB. The purpose of this qualitative and explorative study was to explore the influence of socio-cultural factors in causing patient delay in seeking early treatment for symptoms of TB. Understanding of socio-cultural factors in patient delay may help health care workers and policy makers in providing counseling and education to the patients as well as to the community members about the importance of early care. A total of 110 rural TB patients were interviewed using semi-structured interview schedule. 68% of the total patients waited one month or more before seeking professional care. Participants of this study explained that a number of factors contributed to delay in seeking treatment for early symptoms. These factors were: failure to recognize the significance of the initial symptoms, 'wait and see' approach, traditional disease causation beliefs, incorrect interpretation of symptoms, attribution of symptoms to less serious illnesses, self medication, negative family history for TB, alcoholism, smoking, low perceived susceptibility to TB, no interference with daily activities, economic and time constraints, herbal treatment, and absence of typical/classic TB symptoms. This study confirms that there is a delay between the onset of symptoms and initiation of appropriate treatment among TB patients in rural Nalgonda. In the biomedical framework, this delay in seeking health care is blamed on the patient who is often regarded as illiterate, negligent, ignorant, and who is made to feel guilty about it. However, the findings of this study clearly suggest there is a need to understand the complex range of socio-cultural factors behind this delay. Health care professionals need to be aware of the fact that patients' socio-cultural belief systems influence variations in healthseeking behavior.
Delay, Tuberculosis, Illness, Disease, Biomedical Model
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