Kuznetsov Vladimir N, Grjibovski Andrej M, Mariandyshev Andrej O, Johansson Eva, Enarson Donald A, Bjune Gunnar A
Institute for Health and Society, University of Oslo, Oslo, Norway.
BMC Public Health. 2013 Aug 2;13:712. doi: 10.1186/1471-2458-13-712.
Data about delayed tuberculosis diagnosis in Northern Russia are scarce yet such knowledge could enhance the care of tuberculosis. The Arkhangelsk region is situated in the north of Russia, where the population is more than one million residents.The aim of the study was to understand factors influencing diagnostic delay among patients with tuberculosis in the Arkhangelsk region and to develop a theoretical model in order to explain diagnostic delay from the patients' perspectives.
Twenty-three patients who had experienced diagnostic delay of tuberculosis were interviewed in Arkhangelsk. Using a qualitative approach, we conducted focus-group discussions for data gathering using Grounded Theory with the Paradigm Model to analyse the phenomenon of diagnostic delay.
The study resulted in a theoretical model of the pathway of delay of tuberculosis diagnosis in the Arkhangelsk region in answer to the question: "Why and how do patients in the Arkhangelsk region delay tuberculosis diagnosis?" The model included categories of causal conditions, context and intervening conditions, action/interaction strategies, and consequences. The causal condition and main concern of the patients was that they were overpowered by hopelessness. Patients blamed policy, the administrative system, and doctors for their unfortunate life circumstances. This was accompanied by avoidance of health care, denial of their own health situations, and self-treatment. Only a deadly threat was a sufficient motivator for some patients to seek medical help. "Being overpowered by hopelessness" was identified as the core category that affected their self-esteem and influenced their entire lives, including family, work and social relations, and appeared even stronger in association with alcohol use. This category reflected the passive position of many patients in this situation, including their feelings of inability to change anything in their lives, to obtain employment, or to qualify for disability benefits.
The main contributing factor to unsuccessful health-seeking behaviour for patients with tuberculosis was identified as "being overpowered by hopelessness." This should be taken into consideration when creating any preventive programs and diagnostic algorithms aimed at increasing knowledge about TB, improving the health system, decreasing alcohol consumption and reducing the poverty of the people in Arkhangelsk.
俄罗斯北部关于结核病延迟诊断的数据稀缺，但此类知识有助于改善结核病的治疗。阿尔汉格尔斯克地区位于俄罗斯北部，人口超过100万。本研究的目的是了解影响阿尔汉格尔斯克地区结核病患者诊断延迟的因素，并构建一个理论模型，以便从患者角度解释诊断延迟现象。
在阿尔汉格尔斯克对23名经历过结核病诊断延迟的患者进行了访谈。采用定性方法，我们运用扎根理论和范式模型进行焦点小组讨论以收集数据，分析诊断延迟现象。
该研究得出了阿尔汉格尔斯克地区结核病诊断延迟路径的理论模型，以回答“为什么以及阿尔汉格尔斯克地区的患者如何延迟结核病诊断？”这一问题。该模型包括因果条件、背景和干预条件、行动/互动策略以及后果等类别。患者的因果条件和主要担忧是他们被绝望情绪笼罩。患者将自己不幸的生活境遇归咎于政策、行政体系和医生。这伴随着对医疗保健的回避、对自身健康状况的否认以及自我治疗。只有致命威胁才足以促使一些患者寻求医疗帮助。“被绝望情绪笼罩”被确定为影响他们自尊并影响其整个生活（包括家庭、工作和社会关系）的核心类别，并且在与饮酒相关时显得更为强烈。这一类别反映了许多患者在这种情况下的被动地位，包括他们觉得无法改变生活中的任何事情、无法获得工作或获得残疾福利的感觉。
结核病患者寻求医疗行为不成功的主要促成因素被确定为“被绝望情绪笼罩”。在制定任何旨在增加结核病知识、改善卫生系统、减少酒精消费以及减轻阿尔汉格尔斯克地区民众贫困状况的预防计划和诊断算法时，都应考虑到这一点。
