"I consulted so many doctors": the journey of tuberculosis patients in Bengaluru, India, from first symptoms to diagnosis

Abstract

Background: The circumstances and factors that explain diagnostic and treatment delays in TB are complex. The present study was planned to understand the journey of new pulmonary TB patients from the time they had their first symptom(s) up to the time they started treatment at a government or private health facility in Bengaluru, a metropolitan city in India.

Methods: In depth interviews were conducted with twenty-six bacteriologically positive TB patients (15 male, 11 females aged 18-56 years) put on first line anti-TB treatment at government and private health facilities in Bengaluru city. Thematic content analysis of the transcript was done using the Framework approach. Constructs of the Health Belief Model were used to create codes in the framework.

Results: Delays were seen in TB diagnosis and treatment in government and private sectors. Pill burden and long duration of treatment were barriers perceived by patients. Myths and lack of knowledge about TB were documented. Patients acknowledged help provided by Non-Government Organizations. All TB patients had received Direct Benefit Transfer support from the national programme.

Conclusions: Empowering private providers to diagnose TB early and enabling channels for seamless referrals to a facility where anti TB treatment is provided is suggested. Tailored counselling by grass root health workers to deal with pill burden and long duration of treatment may be considered. Dissemination of knowledge about TB at community level by making it a part of agenda during routine interactions may be useful. Supporting wider engagement with non-government organizations in TB diagnosis and follow-up during treatment is recommended.

Keywords: Health belief model; India; Journey; TB patients; Urban.

Fig. 1

Conceptual diagram of the role of constructs of the health belief model as explanators of TB patients’ journey in this study