Hopelessness as a basis for tuberculosis diagnostic delay in the Arkhangelsk region: a grounded theory study

BMC Public Health

Gunnar A Bjune⁵  Donald A Enarson³  Eva Johansson¹  Andrej O Mariandyshev⁶  Andrej M Grjibovski²  Vladimir N Kuznetsov⁴ 

[1] Nordic School of Public Health, Gothenburg, Sweden;Department of International Public Health, Norwegian Institute of Public Health, Oslo, Norway;International Union against Tuberculosis and Lung Diseases, Paris, France;Northern State Medical University, Troitskii Ave 51, Arkhangelsk, 163000, Russia;Institute for Health and Society, University of Oslo, Oslo, Norway;Department of Tuberculosis, Northern State Medical University, Arkhangelsk, Russia

关键词: Grounded theory;    Qualitative research;    Tuberculosis;    Diagnostic delay;   

Others  :  1161970
DOI  :  10.1186/1471-2458-13-712

 received in 2012-10-15, accepted in 2013-07-16,  发布年份 2013

【 摘 要 】

Background

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.

Methods

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.

Results

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.

Conclusion

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.

【 授权许可】

   
2013 Kuznetsov et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Diez M, Bleda MJ, Alcaide J, Castells C, Cardenal JI, Dominguez A, Gayoso P, Guitierrez G, Huerta C, Lopez MJ, et al.: Determinants of health system delay among confirmed tuberculosis cases in Spain. Eur J Public Health 2005, 15(4):343-349.
• [2]Karim F, Islam MA, Chowdhury AM, Johansson E, Diwan VK: Gender differences in delays in diagnosis and treatment of tuberculosis. Health Policy Plan 2007, 22(5):329-334.
• [3]Storla DG, Yimer S, Bjune GA: A systematic review of delay in the diagnosis and treatment of tuberculosis. BMC Public Health 2008, 8:15. BioMed Central Full Text
• [4]Arkhangelsk Regional Antituberculosis Dispancery. http://www.tub-info.ru/info/ webcite
• [5]Mitnick CD, Appleton SC, Shin SS: Epidemiology and treatment of multidrug resistant tuberculosis. Semin Respir Crit Care Med 2008, 29(5):499-524.
• [6]Mariandyshev AO, Toungussova OS, Baranov AA: Molecular epidemiology of tuberculosis in Barents region of Russian federation. Medicinskii Akad J 2007, 4(7):59-69.
• [7]Baranov AA, Mariandyshev AO, Mannsaker T, Dahle UR, Bjune GA: Molecular epidemiology and drug resistance of widespread genotypes of mycobacterium tuberculosis in northwestern Russia. Int J Tuberc Lung Dis 2009, 13(10):1288-1293.
• [8]Toungoussova OS, Caugant DA, Sandven P, Mariandyshev AO, Bjune G: Drug resistance of mycobacterium tuberculosis strains isolated from patients with pulmonary tuberculosis in Archangelsk, Russia. Int J Tuberc Lung Dis 2002, 6(5):406-414.
• [9]Toungoussova OS, Sandven P, Mariandyshev AO, Nizovtseva NI, Bjune G, Caugant DA: Spread of drug-resistant mycobacterium tuberculosis strains of the Beijing genotype in the Archangel Oblast, Russia. J Clin Microbiol 2002, 40(6):1930-1937.
• [10]Long Q, Li Y, Wang Y, Yue Y, Tang C, Tang S, Squire SB, Tolhurst R: Barriers to accessing TB diagnosis for rural-to-urban migrants with chronic cough in Chongqing, China: a mixed methods study. BMC Health Serv Res 2008, 8:202. BioMed Central Full Text
• [11]Ayisi JG, van't Hoog AH, Agaya JA, McHembere W, Nyamthimba PO, Muhenje O, Marston BJ: Care seeking and attitudes towards treatment compliance by newly enrolled tuberculosis patients in the district treatment programme in rural western Kenya: a qualitative study. BMC Public Health 2011, 11:515. BioMed Central Full Text
• [12]Gaba PD, Haley C, Griffin MR, Mitchel E, Warkentin J, Holt E, Baggett P, Sterling TR: Increasing outpatient fluoroquinolone exposure before tuberculosis diagnosis and impact on culture-negative disease. Arch Intern Med 2007, 167(21):2317-2322.
• [13]Mfinanga SG, Mutayoba BK, Kahwa A, Kimaro G, Mtandu R, Ngadaya E, Egwaga S, Kitua AY: The magnitude and factors associated with delays in management of smear positive tuberculosis in Dar es Salaam, Tanzania. BMC Health Serv Res 2008, 8:158. BioMed Central Full Text
• [14]Sudha G, Nirupa C, Rajasakthivel M, Sivasusbramanian S, Sundaram V, Bhatt S, Subramaniam K, Thiruvalluvan E, Mathew R, Renu G, et al.: Factors influencing the care-seeking behaviour of chest symptomatics: a community-based study involving rural and urban population in Tamil Nadu, South India. Trop Med Int Health 2003, 8(4):336-341.
• [15]MacKian S: A review of health-seeking behaviour: problems and prospects. In Health Systems Development Programme. Manchester: University of Manchester; 2003.
• [16]Ward H, Mertens TE, Thomas C: Health seeking behaviour and the control of sexually transmitted disease. Health Policy Plan 1997, 12(1):19-28.
• [17]Calnan M: Towards a conceptual framework of lay evaluation of health care. Soc Sci Med 1988, 27(9):927-933.
• [18]Gele AA, Bjune G, Abebe F: Pastoralism and delay in diagnosis of TB in Ethiopia. BMC Public Health 2009, 9:5. BioMed Central Full Text
• [19]Vallis TM, Mchugh S: Illness Behavior. Health Care: Challenging the Medical Model. Human medicine; 2010:3(1).
• [20]Arkhangelsk Official Internet Portalhttp://www.arhcity.ru/?page=31/2 webcite
• [21]Government of Arkhangelsk Oblasthttp://www.dvinaland.ru/region/ webcite
• [22]Federal State Statistic Service of Russian Federationhttp://www.gks.ru/ webcite
• [23]Strauss A, Corbin J: Basic of qualitative research: grounded theory procedures and techniques. London: SAGE Publication; 1998.
• [24]Glaser BG, Strauss A: The discovery of grounded theory. Strategies for qualitative research. Chicago: Adline; 1967.
• [25]Denzin NK, Lincoln YS: Handbook of Qualitative research. 2nd edition. California: SAGE; 2000.
• [26]Creswell JW: Qualitative inquiry and research design: Choosing among five approaches. 2nd edition. Thousand Oaks: SAGE publication; 2007.
• [27]Barbour RS, Kitzinger J: Developing Focus Group Research: Politics, Theory and Practice. London: Sage Publications; 1998.
• [28]Kreuger RA, Casey M: Focus Groups: A Practical Guide for Applied Research. 3rd edition. Thousand Oaks: California Sage Publications Inc; 2000.
• [29]Morgan DL: Focus Groups as Qualitative Research, Volume 16. 2nd edition. Thousand Oaks London New Delhi: Portland State University: SAGE PUBLICATIONS; 1997.
• [30]Kitzinger J: Qualitative research. introducing focus groups. BMJ 1995, 311(7000):299-302.
• [31]Geis S, Fuller R, Rush J: Lovers of AIDS victims: psychosocial stresses and counseling needs. Death Stud 1986, 10:43-53.
• [32]Watts M, Ebbutt D: More than the sum of the parts: research methods in group interviewing. Br Educ Res J 1987, 13:25-34.
• [33]Creswell JW: Qualitative Inquiry and Research Design: Choosing among Five Approaches. 2nd edition. London: SAGE Publications, Inc.; 2007.
• [34]Harstad I, Jacobsen GW, Heldal E, Winje BA, Vahedi S, Helvik AS, Steinshamn SL, Garasen H: The role of entry screening in case finding of tuberculosis among asylum seekers in Norway. BMC Public Health 2010, 10:670. BioMed Central Full Text
• [35]Barnes P: The Non-Orthodox: The Orthodox Teaching on Christians Outside of the. Church: Regina Orthodox Press; 2004.
• [36]Johansson E: Emerging perspectives on tuberculosis and gender in Vietnam. Umeå, Sweden: Umeå University; 2000.
• [37]Long NH, Johansson E, Lonnroth K, Eriksson B, Winkvist A, Diwan VK: Longer delays in tuberculosis diagnosis among women in Vietnam. Int J Tuberc Lung Dis 1999, 3(5):388-393.
• [38]Lonnroth K, Raviglione M: Global epidemiology of tuberculosis: prospects for control. Semin Respir Crit Care Med 2008, 29(5):481-491.
• [39]Fleming MF, Krupitsky E, Tsoy M, Zvartau E, Brazhenko N, Jakubowiak W, McCaul ME: Alcohol and drug use disorders, HIV status and drug resistance in a sample of Russian tuberculosis patients. Int J Tuberc Lung Dis 2006, 10(5):565-570.
• [40]Shin SS, Mathew TA, Yanova GV, Fitzmaurice GM, Livchits V, Yanov SA, Strelis AK, Mishustin SP, Bokhan NA, Lastimoso CS, et al.: Alcohol consumption among men and women with tuberculosis in Tomsk, Russia. Central Eur J Publ Health 2010, 18(3):132-138.
• [41]Thomas B, Suhadev M, Mani J, Ganapathy BG, Armugam A, Faizunnisha F, Chelliah M, Wares F: Feasibility of an alcohol intervention programme for TB patients with alcohol use disorder (AUD)–a qualitative study from Chennai, South India. PLoS One 2011, 6(11):e27752.