The duration and influencing factors of patient delay among pulmonary tuberculosis patients in a high burden area, Thailand

Kampanart Chaychoowong

Abstract

Background
Pulmonary tuberculosis (PTB) is an infectious disease caused by Mycobacterium tuberculosis complex. Although there have been many campaigns and strategies to end tuberculosis across the world for over two decades, it still remains in the top ten causes of death among humankind. Patient delay, the duration between the first onset of any TB-related symptoms and the first visit to any health providers is significantly related to both individual and community level in terms of an increased deaths and new TB cases. This study aimed to explore the duration and influencing factors of patient delay among pulmonary tuberculosis patients in a high burden area, Thailand.
Design and methods
An explanatory sequential mixed methods design was adopted to discover the factors influencing patient delay which included two phases. In terms of quantitative phase, a descriptive cross-sectional design was addressed to identify the duration and influencing factors. The data were collected by surveys with a structured questionnaire among new 300 PTB patients. Descriptive statistics were used to describe information by percentage, distribution, mean, standard deviation, median, minimum and maximum. Inferential statistics were addressed to investigate the influencing factors by Chi-square test and Mann-Whitney U test for univariate analysis, and Multiple logistic regression test for multivariate analysis. In terms of the qualitative phase, individual in-depth interviews were undertaken among 25 PTB patients identified with patient delay. The data were collected by a semi-structured questionnaire and unstructured questions, and were analysed by content analysis based on themes.
Results
The quantitative findings showed that 39.33% of participants showed patient delay (more than 30 days). The median duration of the delay was 60 days among participants with common signs and symptoms. By multivariate analysis, the factors significantly influencing the delay were primary education (OR = 3.45, 95% CI = 1.62 – 7.33), upper secondary education (OR = 2.88, 95% CI = 1.01 – 8.20), previous TB knowledge (OR = 3.42, 95% CI = 1.29 – 9.12), recognition that TB is a somewhat serious disease (OR = 0.37, 95% CI = 0.19 – 0.75), stigmatisation of TB (OR = 1.08, 95% CI = 1.02 – 1.14), weight loss (OR = 2.37, 95% CI = 1.28 – 4.36), self-treatment (OR = 3.04, 95% CI = 1.54 – 6.03), the number of consultations with health providers (OR = 2.25, 95% CI = 1.52 – 3.33), and taking a motorcycle to the hospital (OR =0.51, 95% CI = 0.28 – 0.93). The qualitative findings showed that there were many influencing factors including six main factors; 1) sociodemographic-economic factors; 2) knowledge, recognition; and stigmatisation about TB factors; 3) family and social factors; 4) health seeking behaviour factors; 5) accessibility and availability to TB services factors; and 6) satisfaction with health care services factors. By combining both strands, there were, therefore, only four factors namely knowledge, financial barrier, residence area, and social support influencing patient delay.
Conclusion
These results suggest that encouraging more education and gaining more knowledge about the disease can be used to improve adequate TB knowledge; establishing TB corners in factories, improving the health care system—especially primary care, and enhancing the competence of health providers and village health volunteers in the community can be used to address the problems resulting from financial barriers and residence area; and encouraging social support for the family and the community can help to enhance social support. These suggestions may help to decrease the death rate among PTB patients and the transmission rate of TB.

Citation

Kampanart Chaychoowong. The duration and influencing factors of patient delay among pulmonary tuberculosis patients in a high burden area, Thailand. (Thesis). University of Hull. https://hull-repository.worktribe.com/output/4223068

• Thesis Type: Thesis
• Deposit Date: Apr 8, 2021
• Publicly Available Date: Feb 23, 2023
• Keywords: Health studies
• Public URL: https://hull-repository.worktribe.com/output/4223068
• Additional Information: Department of Health Studies, The University of Hull
• Award Date: Jun 1, 2020