| Objectives To explore the patient's patterns of health seeking for tuberculosis and the factors related to individuals, socio-economic, health services and cultural context influence the health seeking behavior of tuberculosis patients attending county tuberculosis dispensaries in rural Hunan province, China.Methods A cross-sectional descriptive survey was conducted in 4 counties randomly stratified by economic status from 122 counties, Hunan, China. After obtaining informed consent, a consecutive sample of patients, aged 15 years and over, with smear-positive pulmonary tuberculosis was interviewed and completed a pre-tested questionnaire from the sampling county tuberculosis dispensaries. All data derived from the questionnaire were processed using the SPSS software package (version 11.0) for univarite analysis and multivarite analysis.Results A total of 318 patients with smear-positive pulmonary tuberculosis were interviewed and completed questionnaire during the study period. Among the respondents, 229 are male and the rest are female, with the average age of 38.2 years old. Most of the patients (81.4%) have a somewhat lower per capita income than that of local rural residents. The majority of patients have no medical insurance at all, but nonetheless initially chose to attend general hospitals (33.3%), township clinics (33.0%), village clinics or private practitioners (21.8%), traditional health clinics (5.7%) and others (0.9%), Only 5.3% of these visited the local county tuberculosis dispensaries first because they knew that free tuberculosis diagnosis and treatment are available. 24.8% of these patients had visited temples and asked Bodhisattva to cure theirdisease or visited traditional healers, while 34.9% had visited folk herbalists before diagnosis. Women are more likely to believe folk healing than men. Among 318 participants, the average health care encounters were 2.46 before they come to county TB dispensaries, the median of patient delay (the interval form onset of symptoms/signs to initially seeking care), health system delay (the interval form first consultation with a doctor to diagnosis is made) and total delay (the interval from onset of symptoms to diagnosis is made) were 30, .24 and 65 days, respectively. 58.5% of patients delay seeking care for more than 2 weeks, of whom 41.7% attributed the delay to economic constraints. Logistic regression shows that the patient delay are significantly associated with the following 5 factors: haemoptysis, far distance to health institute, superstition behaviors, prior visited folk herbalists and lower per capita income. 62.9% respondents had got more than 2 weeks health system delay and 41.5% of them attributed the delay to transportation difficulties. Logistic regression reveals that the factors associate with health system delay are female, lower level of education, prior received health education on tuberculosis, superstition behaviors, prior visited folk herbalists and stigma associated with tuberculosis.Conclusion To keep awareness for tuberculosis and reduce the diagnostic delay, extensive training of medical staff in the non-tuberculosis health facilities is urgent needed. The referral chains should be strengthened, particularly among medical personal including private practitioners in the non-tuberculosis health facilities. Traffic inconvenience and far distance to tuberculosis dispensary have shown a significant impact on patient delay. Therefore, further decentralization services of TB diagnostic and treatment should be considered. Although health education is a priority in NTP, the findings may imply that TB education programs should be sensitive to the different target population, especially women, less educated and lower socio-economic status people, so that old, erroneous beliefs can be corrected, stigmatization ofthe disease should be changed. Key to TB education for generalpopulation is to increase the awareness of the signs/symptoms oftuberculosis and ensuring easy access to diagnostic facilities andtreatment. |
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