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Barriers to accessing TB diagnosis for rural-to-urban migrants with chronic cough in Chongqing, China: a mixed methods study.

Long Q, Li Y, Wang Y, Yue Y, Tang C, Tang S, Squire SB, Tolhurst R - BMC Health Serv Res (2008)

Bottom Line: Sixty eight percent of migrants delayed for more than two weeks before seeking care for symptoms suggestive of TB, compared to 54% of residents (p < 0.01).Only 5% were ultimately referred to a TB dispensary.In the follow up survey, 61% of the migrants and 41% of the residents who still had symptoms gave up continuing to seek professional care, with a statistically significant difference between the two groups (p < 0.05).

View Article: PubMed Central - HTML - PubMed

Affiliation: School of Public Health, Chongqing Medical University, No.1 Yixueyuan Road, Chongqing, PR China. longqian620@163.com

ABSTRACT

Background: China is facing a significant tuberculosis epidemic among rural-to-urban migrants, which poses a threat to TB control. This study aimed to understand the health seeking behaviour of and health systems responses to migrants and permanent urban residents suffering from chronic cough, in order to identify the factors influencing delays for both groups in receiving a TB diagnosis in urban China.

Methods: Combining a prospective cohort study of adult suspect TB patients and a qualitative study, the Piot model was used to analyze the health seeking behaviour of TB suspects among migrants and permanent urban residents, the factors influencing their decision and the responses by general health providers. Methods included a patient survey, focus group discussions with migrants in the general population, qualitative interviews with migrant and permanent resident TB suspects and TB patients as well as key stakeholders related to TB control and the management of migrants.

Results: Sixty eight percent of migrants delayed for more than two weeks before seeking care for symptoms suggestive of TB, compared to 54% of residents (p < 0.01). When they first decided to seek professional care, migrants were 1.5 times more likely than residents to use less expensive, community-level health services. Only 5% were ultimately referred to a TB dispensary. Major reasons for both patient and provider delay included lack of knowledge and mistrust of the TB control programme, lack of knowledge about TB (patients), and profit-seeking behaviour (providers). In the follow up survey, 61% of the migrants and 41% of the residents who still had symptoms gave up continuing to seek professional care, with a statistically significant difference between the two groups (p < 0.05).

Conclusion: Rural-to-urban migrants are more likely than permanent residents to delay in seeking care for symptoms suggestive of TB in urban Chongqing. 'Patient-' and 'provider-' related factors interact to pose barriers to TB diagnosis for migrants, including: low awareness, and poor knowledge among both the general public and TB suspects about TB as a disease and about the TB control programme; low financial capacity to pay for care and diagnostic tests; and inadequate use of diagnostic tests and referral to TB dispensaries by general health providers.

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Comparison of health seeking behaviour among migrants and residents who were still suffering from the symptoms in the follow-up survey. The chart compares the measures taken in the follow-up survey among the migrants and the residents who were still suffering from the symptoms.
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Figure 2: Comparison of health seeking behaviour among migrants and residents who were still suffering from the symptoms in the follow-up survey. The chart compares the measures taken in the follow-up survey among the migrants and the residents who were still suffering from the symptoms.

Mentions: In the follow up survey, 61% of the migrants and 41% of the residents who still had symptoms gave up continuing to seek professional care (Figure 2). The difference between the two groups is statistically significant (p < 0.05). Among those who sought professional care, more patients selected the district and municipal hospital as well as TB dispensary, and fewer selected private clinics/community clinics.


Barriers to accessing TB diagnosis for rural-to-urban migrants with chronic cough in Chongqing, China: a mixed methods study.

Long Q, Li Y, Wang Y, Yue Y, Tang C, Tang S, Squire SB, Tolhurst R - BMC Health Serv Res (2008)

Comparison of health seeking behaviour among migrants and residents who were still suffering from the symptoms in the follow-up survey. The chart compares the measures taken in the follow-up survey among the migrants and the residents who were still suffering from the symptoms.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2567973&req=5

Figure 2: Comparison of health seeking behaviour among migrants and residents who were still suffering from the symptoms in the follow-up survey. The chart compares the measures taken in the follow-up survey among the migrants and the residents who were still suffering from the symptoms.
Mentions: In the follow up survey, 61% of the migrants and 41% of the residents who still had symptoms gave up continuing to seek professional care (Figure 2). The difference between the two groups is statistically significant (p < 0.05). Among those who sought professional care, more patients selected the district and municipal hospital as well as TB dispensary, and fewer selected private clinics/community clinics.

Bottom Line: Sixty eight percent of migrants delayed for more than two weeks before seeking care for symptoms suggestive of TB, compared to 54% of residents (p < 0.01).Only 5% were ultimately referred to a TB dispensary.In the follow up survey, 61% of the migrants and 41% of the residents who still had symptoms gave up continuing to seek professional care, with a statistically significant difference between the two groups (p < 0.05).

View Article: PubMed Central - HTML - PubMed

Affiliation: School of Public Health, Chongqing Medical University, No.1 Yixueyuan Road, Chongqing, PR China. longqian620@163.com

ABSTRACT

Background: China is facing a significant tuberculosis epidemic among rural-to-urban migrants, which poses a threat to TB control. This study aimed to understand the health seeking behaviour of and health systems responses to migrants and permanent urban residents suffering from chronic cough, in order to identify the factors influencing delays for both groups in receiving a TB diagnosis in urban China.

Methods: Combining a prospective cohort study of adult suspect TB patients and a qualitative study, the Piot model was used to analyze the health seeking behaviour of TB suspects among migrants and permanent urban residents, the factors influencing their decision and the responses by general health providers. Methods included a patient survey, focus group discussions with migrants in the general population, qualitative interviews with migrant and permanent resident TB suspects and TB patients as well as key stakeholders related to TB control and the management of migrants.

Results: Sixty eight percent of migrants delayed for more than two weeks before seeking care for symptoms suggestive of TB, compared to 54% of residents (p < 0.01). When they first decided to seek professional care, migrants were 1.5 times more likely than residents to use less expensive, community-level health services. Only 5% were ultimately referred to a TB dispensary. Major reasons for both patient and provider delay included lack of knowledge and mistrust of the TB control programme, lack of knowledge about TB (patients), and profit-seeking behaviour (providers). In the follow up survey, 61% of the migrants and 41% of the residents who still had symptoms gave up continuing to seek professional care, with a statistically significant difference between the two groups (p < 0.05).

Conclusion: Rural-to-urban migrants are more likely than permanent residents to delay in seeking care for symptoms suggestive of TB in urban Chongqing. 'Patient-' and 'provider-' related factors interact to pose barriers to TB diagnosis for migrants, including: low awareness, and poor knowledge among both the general public and TB suspects about TB as a disease and about the TB control programme; low financial capacity to pay for care and diagnostic tests; and inadequate use of diagnostic tests and referral to TB dispensaries by general health providers.

Show MeSH
Related in: MedlinePlus