Global Health and Tropical Medicine, GHTM, Instituto de Higiene e Medicina Tropical, IHMT, Universidade Nova de Lisboa, UNL, Lisboa, Portugal.
PLoS One. 2021 Dec 28;16(12):e0261688. doi: 10.1371/journal.pone.0261688. eCollection 2021.
Understanding health delivery service from a patient´s perspective, including factors influencing healthcare seeking behaviour, is crucial when treating diseases, particularly infectious ones, like tuberculosis. This study aims to trace and contextualise the trajectories patients pursued towards diagnosis and treatment, while discussing key factors associated with treatment delays. Tuberculosis patients' pathways may serve as indicator of the difficulties the more vulnerable sections of society experience in obtaining adequate care.
We conducted 27 semi-structured interviews with tuberculosis patients attending a treatment centre in a suburban area of Lisbon. We invited nationals and migrant patients in active treatment to participate by sharing their illness experiences since the onset of symptoms until the present. The Health Belief Model was used as a reference framework to consolidate the qualitative findings.
By inductive analysis of all interviews, we categorised participants' healthcare seeking behaviour into 4 main types, related to the time participants took to actively search for healthcare (patient delay) and time the health system spent to diagnose and initiate treatment (health system delay). Each type of healthcare seeking behaviour identified (inhibited, timely, prolonged, and absent) expressed a mindset influencing the way participants sought healthcare. The emergency room was the main entry point where diagnostic care cascade was initiated. Primary Health Care was underused by participants.
The findings support that healthcare seeking behaviour is not homogeneous and influences diagnostic delays. If diagnostic delays are to be reduced, the identification of behavioural patterns should be considered when designing measures to improve health services' delivery. Healthcare professionals should be sensitised and perform continuous capacity development training to deal with patients´ needs. Inhibited and prolonged healthcare seeking behaviour contributes significantly to diagnostic delays. These behaviours should be detected and reverted. Timely responses, from patients and the healthcare system, should be promoted.
从患者的角度了解医疗服务提供情况，包括影响医疗保健寻求行为的因素，对于治疗疾病（尤其是传染病，如肺结核）至关重要。本研究旨在追踪和分析患者在诊断和治疗过程中所经历的轨迹，并讨论与治疗延迟相关的关键因素。肺结核患者的就诊路径可以反映社会中较脆弱群体在获得足够医疗保健方面所面临的困难。
我们对在里斯本郊区一家治疗中心接受治疗的肺结核患者进行了 27 次半结构化访谈。我们邀请正在接受治疗的本国和移民患者分享他们从出现症状到现在的疾病经历，以参与研究。健康信念模型被用作整合定性研究结果的参考框架。
通过对所有访谈的归纳分析，我们将参与者的医疗保健寻求行为分为 4 种主要类型，与参与者主动寻求医疗保健的时间（患者延迟）和卫生系统诊断和开始治疗的时间（卫生系统延迟）有关。确定的每种医疗保健寻求行为（抑制型、及时型、延长型和缺失型）表达了一种影响参与者寻求医疗保健方式的心态。急诊室是启动诊断护理级联的主要入口。初级保健被参与者严重低估。
研究结果表明，医疗保健寻求行为并非同质的，并且会影响诊断延迟。如果要减少诊断延迟，在设计改善卫生服务提供的措施时，应考虑识别行为模式。医疗保健专业人员应提高认识，并进行持续的能力发展培训，以满足患者的需求。抑制型和延长型医疗保健寻求行为会显著导致诊断延迟。这些行为应被发现并纠正。应促进患者和医疗保健系统的及时响应。
