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

Abstract

BackgroundData 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.MethodsTwenty-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.ResultsThe 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.ConclusionThe 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.

Delay in Tuberculosis Diagnosis among Tuberculosis Patients at the Three Hospitals: Asella, Robe and Abomsa of Arsi Zone, Oromia Regional State, March, 2015

“…Alcohol consumption is associated with patient delay. This is in line with study from Russia [29]. Rural residence and being female sex had no statistically significant association with patient delay.…”

Role of acceptability barriers in delayed diagnosis of Tuberculosis: Literature review from high burden countries

“…Seven studies did not specify educational levels of participants (Bennstam et al, 2004;Gosoniu et al, 2008;Johansson and Winkvist, 2002;Murray et al, 2013a;Reyes and Amores, 2014;Skordis-Worrall and Hanson, 2010;Кузнецов et al, 2011). Half of 12 papers did not provide occupational statuses of studied individuals (Bennstam et al, 2004;Kuznetsov et al, 2013;Murray et al, 2013a;Reyes and Amores, 2014;Skordis-Worrall and Hanson, 2010). Authors, reporting these data, included variety of participants with zero years of schooling to higher education.…”

“…Across-study comparison revealed significant differences in their emphasis on demographic/socio-economic aspects of study populations (See: Table 1 in Barnabishvili et al (2016)) In 10 studies, efforts were made for including wide-range of age groups (below15-above70) and to pay equal attention to both gender groups (Bennstam et al, 2004;Edginton M et al, 2002;Gosoniu et al, 2008;Johansson and Winkvist, 2002;Kuznetsov et al, 2013;Long et al, 2008b;Møller and Erstad, 2007;Reyes and Amores, 2014;SkordisWorrall and Hanson, 2010). One paper did not specify the characteristics of the study participants (Murray et al, 2013a), and one was a single case study, reporting one male interviewee (Кузнецов et al, 2011).…”

“…All studies were published as journal articles (Bennstam et al, 2004;Edginton M et al, 2002;Gosoniu et al, 2008;Johansson and Winkvist, 2002;Kuznetsov et al, 2013;Long et al, 2008b;Møller and Erstad, 2007;Murray et al, 2013a;Skordis-Worrall and Hanson, 2010;Кузнецов et al, 2011) or book chapters (Reyes and Amores, 2014). Eleven studies employed qualitative study design with in-depth interviews and/or Focus Group Discussions (Bennstam et al, 2004;Edginton M et al, 2002;Gosoniu et al, 2008;Johansson and Winkvist, 2002;Kuznetsov et al, 2013;Long et al, 2008b;Møller and Erstad, 2007;Reyes and Amores, 2014;Skordis-Worrall and Hanson, 2010;Кузнецов et al, 2011); One was a secondary analysis (Murray et al, 2013a).…”

“…Acceptability barriers in accessing TB diagnostic services were emphasized in recent studies. TBassociated stigma, as well as perceptions about treatment efficiency, severity/importance of symptoms and of the disease itself, is known to be associated with the delayed diagnosis (Kuznetsov et al, 2013;Murray et al, 2013b;. However, the relationship between acceptability barriers and delays in the TB-diagnosis still lacks conceptual clarity.…”