‘Complex’ but coping: experience of symptoms of tuberculosis and health care seeking behaviours - a qualitative interview study of urban risk groups, London, UK

Abstract

BackgroundTuberculosis awareness, grounded in social cognition models of health care seeking behaviour, relies on the ability of individuals to recognise symptoms, assess their risk and access health care (passive case finding). There is scant published research into the health actions of ‘hard-to-reach’ groups with tuberculosis, who represent approximately 17% of the London TB caseload. This study aimed to analyse patients’ knowledge of tuberculosis, their experiences of symptoms and their health care seeking behaviours.MethodsQualitative interviews were conducted with 17 participants, predominantly homeless and attending a major tuberculosis centre in London, UK. Most had complex medical and social needs including drug and alcohol use or immigration problems affecting entitlement to social welfare. Analytical frameworks aimed to reflect the role of broader social structures in shaping individual health actions.ResultsAlthough participants demonstrated some knowledge of tuberculosis their awareness of personal risk was low. Symptoms commonly associated with tuberculosis were either not recognised or were attributed to other causes for which participants would not ordinarily seek health care. Many accessed health care by chance and, for some, for health concerns other than tuberculosis.ConclusionsHealth education, based on increasing awareness of symptoms, may play a limited role in tuberculosis care for populations with complex health and social needs. The findings support the intensification of outreach initiatives to identify groups at risk of tuberculosis and the development of structured care pathways which support people into prompt diagnosis and treatment.

Knowledge and Perceptions about Tuberculosis in Agropastoral Communities in Northern Tanzania: A Cross-Sectional Study

“…Studies conducted in Tanzania show that poor knowledge on causes and transmission of tuberculosis among the Maasai people was associated with low level of schooling [28,29]. The importance of knowledge in reducing disease burden by promoting early diagnosis and adherence to treatment has been emphasized [30]. The reported low knowledge on causes and mode of transmission of tuberculosis in our study highlights current implementation gaps by health programmes in the study community.…”

The access of the homeless persons with tuberculosis to the health care: an integrative review

“…The homeless individuals are less inclined to complete the TB treatment than the ones with residence, even when the treatment is given by direct observation. Thus, this population presents low adhesion to the 7 TB treatment, bearing in mind treating about a population with transitory characteristic, exposed to many social risk factors and presenting much comorbidity [25][26][27][28]. In this scenario is noteworthy that generally the aspects that disfavor the precocious diagnostic also difficulties the TB treatment adhesion, emphasizing the health services necessity to produce a singularity care, based on this vulnerable group specific health necessities.…”

“…Being the TB on the homeless people initially diagnosed and treated at the hospital [30,31,28,27]. Thus, the homeless people are hospitalized at the hospital 5 times more frequently than the general population and stay there longer than the other low income patients [27].…”

“…The homeless people have a high risk to get sick per TB, presenting the TB incidence rate 10 to 20 times more than the general population [25][26][27][28][29]. Those people present, still, a high risk to die, presenting mortality rate by TB approximately 4 times higher than the general population [26][27].…”

“…The homeless people only search the care if they consider to be in serious situation, once the patients tend to normalize their symptoms in their daily context [30,31,37]. As the symptoms are attributed to the causes that the participants don't search for medical care, as for drugs and alcohol abstinence, tiredness attributed to weak feeding, by economical reasons, and other condition in the long term, this indicates the facility that the serious disease can be lost by the ones who lives in a complexity of health questions and social questions [28].…”