Institute of General Practice and Community Medicine, University of Oslo, Oslo, Norway.
Scand J Public Health. 2010 May;38(3):283-90. doi: 10.1177/1403494809357101. Epub 2010 Jan 7.
The aim of this paper is to explore experiences of being diagnosed with tuberculosis (TB) among immigrants in Norway, with a view to factors associated with diagnostic delay.
A qualitative study was conducted among 22 participants diagnosed with TB who originated from Somalia or Ethiopia.
One-third of the participants reported less than 2 months from onset of symptoms to treatment were initiated. The factors associated with little delay included a medical history that gave suspicion of TB, presenting with typical TB symptoms, or being screened for TB at arrival. Two-thirds of the participants told about extensive diagnostic processes. Persistent cough not accompanied by symptoms such as: weight loss and weakness; mild, diffuse, atypical, and/or intermittent symptoms; and a sense of not being a likely victim of TB could delay patients' first initiative to seek help. Participants experienced that the diagnostic process in the health services could endure for months, even years. The diagnosis could be difficult to confirm, but health professionals appeared to have difficulties with associating their symptoms with TB. This resulted in delays in initiating diagnostic tests for TB, especially in cases of extra-pulmonary TB.
Public health efforts to increase awareness about TB transmission, its diversity in manifestations, and its progression from latent to active disease, may decrease patient delay. An increased awareness among health professionals about typical and atypical symptoms of TB, aspects of the patient's history, and being aware and sensitive to patients' own interpretation of symptoms may reduce diagnostic delay in the health services.
本文旨在探讨挪威移民中诊断为结核病（TB）的经历，以期探讨与诊断延迟相关的因素。
对 22 名原籍为索马里或埃塞俄比亚、被诊断为结核病的参与者进行了定性研究。
三分之一的参与者报告说，从出现症状到开始治疗的时间少于 2 个月。与延迟时间较短相关的因素包括：有疑似结核病的病史、出现典型的结核病症状、或在抵达时接受结核病筛查。三分之二的参与者讲述了广泛的诊断过程。持续咳嗽但不伴有体重减轻和乏力等症状；轻度、弥散、非典型和/或间歇性症状；以及感觉不太可能患有结核病，这些都可能导致患者首次寻求帮助的时间延迟。参与者发现，卫生服务机构的诊断过程可能会持续数月甚至数年。诊断可能难以确认，但卫生专业人员似乎难以将其症状与结核病联系起来。这导致对结核病的诊断测试延迟，特别是在肺外结核病的情况下。
提高公众对结核病传播、其表现多样性以及从潜伏状态向活动性疾病发展的认识，可能会减少患者的延迟。卫生专业人员对结核病的典型和非典型症状、患者病史的各个方面以及对患者自身症状解释的认识和敏感性的提高，可能会减少卫生服务中的诊断延迟。
