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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
- Allan WGC, Girling, DJ, Fayers PM and Fox W. The symptoms of newly diagnosed pulmonary tuberculosis patients’ attitudes to the disease and its treatment in Hong Kong. Tubercle. 1979; 60: 211-223.
- Atre SR, Kudale A M, Morankar SN, Rangan, SG and Weiss MG. Cultural concepts of tuberculosis and gender among the general population without tuberculosis in Rural Maharastra, India. Tropical Medicine & International Health. 2004; 9(11): 1228-1238.
- Auer C, Sarol Jr, Jesus T, Marcel and Weiss M. Health seeking and perceived causes of tuberculosis among patients in Manila, Philippines. Tropical Medicine & International Health. 2000; 5 (9): 648-656.
- Burgess R. From Key Variables in Social Investigation. Routledge, London. 1986.
- Cambanis A, Yassin MA, Ramsay A, Squire SB, et al. Rural poverty and delayed presentation to tuberculosis services in Ethiopia. Tropical Medicine & International Health. 2005; 10(4): 330-335.
- Cheng G, Tolhurst R, Li RZ, et al. Factors affecting delays in tuberculosis diagnosis in rural China: A case study in four counties in Shandong Province. Transactions of the Royal Society for Tropical Medicine & Hygiene. 2005; 99: 355-362.
- Dracup K, Moser DK, et al. Beyond sociodemographics: Factors influencing the decision to seek treatment for symptoms of acute myocardial infarction. Heart and Lung. 1997; 26(4): 253-262.
- Fabrega, Jr. H. (1975) The need for an ethnomedical science. Science New Series, 189(4207): 969-975.
- Green A. An Introduction to Health Planning in Developing Countries. Oxford University Press, London. 1992
- Helman CG. Disease versus illness in general practice. Journal of the Royal College of General Practitioners. 1981; Vol 31:548-552.
- Hierscher S and Sommerfeld J. Concepts of illness and the utilization of health care services in rural Malian village. Social Science and Medicine. 1985; 21(4): 469-481.
- Kleinman A. Patients and Healers in the Context of Culture. University of California Press, London. 1980.
- Kleinman, A. Writing at the Margin: Discourse between anthropology and Medicine. University of California Press, Berkely. 1995.
- Lawn SD, Afful B, Acheampong JW. Pulmonary tuberculosis: diagnostic delay in Ghanaian adults. International Journal of Tuberculosis and Lung Disease. 1988; 2: 635-640.
- Lieban RW. Traditional medical beliefs and the choice of practitioners in a Philippine city. Social Science and Medicine. 1976; 10: 289-296.
- Liefooghe R, Baliddawa JB, Kipruto EM, Vermeire C and De Munynck AO. From their own perspective: A Kenyan community’s perception of tuberculosis. Tropical Medicine & International Health. 1997; 2(8): 809-821.
- Long NN, Johansson E, Lonnroth K, et al. Longer delays in tuberculosis diagnosis among women in Vietnam. International Journal of Tuberculosis and Lung Disease. 1998; 3(5): 388-393.
- Mohan A. & Sharma SK. Epidemiology. In Sharma SK & Mohan A (eds.). Tuberculosis. Jaypee Brothers, Medical Publishers P (LTD), New Delhi. 2001.
- Rajeswari R, Chandrasekaran V, Suhadev M, et al. Factors associated with patient and health system delays in the diagnosis of tuberculosis in South India. International Journal of Tuberculosis and Lung Disease. 2002; 6(9): 789-795.
- Rubel AJ and Garro LC. Social and cultural factors in the successful control of Tuberculosis. Public Health Reports. 1992;107(6): 626-636.
- TB India 2007: RNTCP Status Report. Central TB Division, DGHS, Mo Health and F W, New Delhi. 2007.
- Wandwalo ER and Morkve O. Delay in tuberculosis casefinding and treatment in Mwanza, Tanzania. International Journal of Tuberculosis and Lung Disease. 2000; 4(2): 133-138.
- Ware NC and Kleinman A. Culture and somatic experience: The social course of illness in Neurasthenia and chronic fatigue syndrome. Psychosomatic Medicine. 1992; 54:546-560.
- WHO (1998) Emerging Infectious Diseases in the South-East Asia Region. 50 Years: Commemorative Series-6. Regional Office for South-East Asia, New Delhi. 1998.
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