scholarly journals The circuits of healthcare: Understanding healthcare seeking behaviour—A qualitative study with tuberculosis patients in Lisbon, Portugal

PLoS ONE ◽  
2021 ◽  
Vol 16 (12) ◽  
pp. e0261688
Author(s):  
Rafaela M. Ribeiro ◽  
Philip J. Havik ◽  
Isabel Craveiro
Keyword(s):  
Health System ◽  
Health Belief ◽  
System Delay ◽  
Structured Interviews ◽  
Tuberculosis Patients ◽  
Healthcare Seeking ◽  
Health System Delay ◽  
Services Delivery ◽  
Belief Model ◽  
Diagnostic Delays

Background 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. Methods 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. Results 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. Conclusions 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.

Health system delay in the treatment of tuberculosis patients in Ethiopia: a systematic review and meta-analysis

2021 ◽  
Author(s):  
Kenaw Tegegne ◽  
Fasil Wagnew ◽  
Yihalem Abebe Belay ◽  
Dawit Eyayu ◽  
Daniel Bekele
Keyword(s):  
Systematic Review ◽  
Health System ◽  
Median Time ◽  
Meta Analysis ◽  
A Priori ◽  
Rural Residence ◽  
System Delay ◽  
Tuberculosis Patients ◽  
Delay In Diagnosis ◽  
Health System Delay

Abstract Background: Delay in diagnosis and initiation of effective treatment associated with increase in morbidity, mortality and on-going person-to-person transmission in the community at large. In Ethiopia, several studies have been conducted regarding health system delay among tuberculosis patients. However, studies assessing the health system delay in treatment of tuberculosis patients in Ethiopia had inconsistent and inconclusive findings. Therefore, this systematic review and meta-analysis aimed to determine the pooled median time of the health system delay in the treatment of tuberculosis and its determinants in Ethiopia. Methods: We systematically searched from different databases: Google Scholar, Science Direct, PubMed, Embase, Scopus and Springer link databases for studies published from June 6, 1997 up to December 20, 2020. The quality of the studies was assessed using the Newcastle-Ottawa scale adapted for observational studies. Heterogeneity was evaluated using I squared statistic. We conducted a meta-analysis for the pooled median time of health system delay and its determinants using random-effects model in R version 4.0.3 software(for median estimation) and Stata version 14 (for metan). The pooled estimates with 95% confidence intervals (CI) were presented using forest plots. Results: A total of 14 studies which comprising 6161 patients satisfying a priori set criteria were included. Our meta-analysis showed that, the estimated pooled median time of the health system delay was 15.29(95%CI: 9.94–20.64) days. In the subgroup analysis, studies conducted from 1997 to 2015 the pooled median health system delay was 21.63(95% CI: 14.38-28.88) days, whereas studies conducted after 2015 the pooled median time of 9.33(95% CI: 3.95-14.70) days. Living in rural area (pooled OR: 2.42, 95%CI: 1.16-5.02) was significantly associated with health system delay. Conclusions: In Ethiopia, patients are delayed more-than two weeks in the treatment of tuberculosis. Being from rural residence was more likely to lead prolonged health system delay. Implementing efforts by targeting rural residence may help to shorten the health system delay and important implications for the success of tuberculosis control.

scholarly journals Patient and health care system characteristics are associated with delayed treatment of tuberculosis cases in Taiwan

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Chien-Chou Chen ◽  
Po-Huang Chiang ◽  
Yen-Hsu Chen ◽  
I-Chun Fan ◽  
Ta-Chien Chan
Keyword(s):  
Risk Factors ◽  
Health Care ◽  
Health System ◽  
Health Care System ◽  
Initial Visit ◽  
System Delay ◽  
Tuberculosis Patients ◽  
Health System Delay ◽  
Treatment Services ◽  
Care System

Abstract Background The decline of the incidence rate of tuberculosis in Taiwan has been partly attributed to the launch of the directly observed therapy short course (DOTS) program in 2006, followed by the DOTS-Plus in 2007. However, with the phasing out of the specialized tuberculosis care system and the declining incidence, clinical workers in Taiwan might become less familiar with the presentation of tuberculosis. Complementing the patient-pathway analysis with health system delay estimates, the objective of this study is twofold: to estimate the alignment between patient care initiation and the availability of prompt diagnostic and treatment services, and to identify the risk factors of delayed tuberculosis treatment. Methods The study population included all Taiwanese patients with incident tuberculosis in 2013. We (1) identified 11,507 incident tuberculosis patients from the 2013 National TB Registry, and (2) linked 10,932 Taiwanese from the registry to the 2012–2013 National Health Insurance Research Database. We assessed patient’s care-seeking pathways and associated the determinants of health system delay in a Cox model. Results The overall health system delay was 46 days. We found that 20.5 and 3.5% of 10,932 tuberculosis patients were diagnosed and treated respectively at the initial visit to seek care for TB-related symptoms. Risk factors related to the prolonged health system delay included female gender (adjusted HR = 0.921, 95% CI: 0.884, 0.960), age > =65 years (adjusted HR = 0.720, 95% CI: 0.692, 0.750), non-severe (chest X-ray without cavities) (adjusted HR =0.721, 95% CI 0.683–0.760), chronic respiratory diseases (adjusted HR = 0.544, 95% CI: 0.522, 0.566), living in long-term care facilities (adjusted HR = 0.580, 95% CI: 0.525,0.640), an initial visit at a primary care clinic (adjusted HR = 0.588, 95% CI: 0.565, 0.612), and living in southern Taiwan (adjusted HR = 0.887, 95% CI: 0.798, 0.987). Conclusions The low access to TB diagnostic and treatment services at the initial visit and the prolonged health system delay indicate inefficiency in the health care system. Strengthening training of physicians at public hospitals and health workers at nursing homes might improve the efficiency and timeliness of tuberculosis diagnosis and treatment in Taiwan.

scholarly journals Health System Delay in the Treatment of Tuberculosis Patients in Ethiopia: A Systematic Review and Meta-analysis

2021 ◽  
Vol 6 (4) ◽  
pp. 42
Author(s):  
Kenaw Tegegne Tefera ◽  
Fasil Wagnew ◽  
Yihalem Abebe Belay ◽  
Dawit Eyayu ◽  
Daniel Bekele Ketema
Keyword(s):  
Systematic Review ◽  
Health System ◽  
Meta Analysis ◽  
System Delay ◽  
Tuberculosis Patients ◽  
Health System Delay

Qualitative Analysis of the Cognition and Flow (CoGFlowS) Study: An Individualized Approach to Cognitive Training for Dementia Is Needed

2021 ◽  
pp. 1-17
Author(s):  
Lucy Beishon ◽  
Victoria Haunton ◽  
Hari Subramaniam ◽  
Elizabeta B. Mukaetova-Ladinska ◽  
Ronney B. Panerai ◽  
...  
Keyword(s):  
Cognitive Training ◽  
Controlled Trial ◽  
Cognitive Disorders ◽  
Health Belief ◽  
Analytical Framework ◽  
Structured Interviews ◽  
Home Based ◽  
Individualized Approach ◽  
Belief Model ◽  
Severity Of Dementia

Background: Cognitive training (CT) may have benefits for both healthy older adults (HC) and those with early cognitive disorders [mild cognitive impairment (MCI) and dementia]. However, few studies have qualitatively evaluated home-based, computerized CT programs. Objective: We present the qualitative arm of a feasibility randomized controlled trial evaluating a CT program for HC and people living with MCI or dementia. Methods: Participants underwent semi-structured interviews after 12 weeks of CT. Where possible, participants were interviewed with their carers. The interview schedule and analysis were underpinned by the health belief model. Interviews were audio-recorded, transcribed, open-coded, and categorized into themes. The analytical framework was developed, and themes were condensed under five major categories: benefits, barriers, threat, self-efficacy, and cues to action. Results: 37 participants underwent interviews. CT was feasible and acceptable to participants. Benefits included: enjoyment, improved awareness, benchmarking cognitive function, reassurance of abilities and giving back control. Barriers were more prevalent among those with dementia: problems with technology, frustration, conflict between patients and carers, apathy and lack of insight, anxiety or low mood, and lack of portability. HC and MCI perceived the severity of dementia risk as high, partially mitigated by CT. Participants living with dementia valued a more individualized approach to training, accounting for baseline characteristics. Conclusion: CT was a feasible intervention for HC and people living with dementia and MCI. Benefits were present, but the identified barriers need to be addressed for CT to be implemented successfully.

scholarly journals Determinants of health system delay among confirmed tuberculosis cases in Spain

2005 ◽  
Vol 15 (4) ◽  
pp. 343-349 ◽  
Author(s):  
M. Díez ◽  
M.J. Bleda ◽  
J. Alcaide ◽  
C. Castells ◽  
J.I. Cardenal ◽  
...  
Keyword(s):  
Health System ◽  
Determinants Of Health ◽  
System Delay ◽  
Health System Delay

scholarly journals The unbooked maternity patient in an academic hospital in Durban

Curationis ◽  
1992 ◽  
Vol 15 (3) ◽  
Author(s):  
R. Gcaba ◽  
H.B. Brookes
Keyword(s):  
Health Services ◽  
Service Failure ◽  
Health Belief ◽  
Interaction Model ◽  
Academic Hospital ◽  
Structured Interviews ◽  
Case Study Methodology ◽  
Study Methodology ◽  
Belief Model ◽  
The Health Belief Model

This paper examines the unbooked maternity patient in an academic hospital in Durban, Natal; This hospital is the biggest hospital serving the underprivileged population of this area. Of the 16000 annual deliveries in this hospital, about 12% are unbooked patients. The health belief model of Rosenstock, as interpreted by Mikhail and Cox’s interaction model of client health behaviour were used as a theoretical framework for this research. A qualitative case study methodology was undertaken and semi-structured interviews were conducted with unbooked mothers who had utilized appropriate health services in a previous pregnancy. The aim of such interviews was to explore reasons given by mothers for non-use of facilities in the current pregnancy. The basic trends reflected in the findings regarding non-utilization of health services were client instability, health service failure and socio-cultural constraints, The study is innovative and addresses the problem from a social-cultural and midwifery perspective.

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