Understanding why at-risk population segments do not seek care for tuberculosis: a precision public health approach in South India
Introduction Delaying care-seeking for tuberculosis (TB) symptoms is a major contributor to mortality, leading to worse outcomes and spread. To reduce delays, it is essential to identify barriers to care-seeking and target populations most at risk of delaying. Previous work identifies barriers only...
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2020-09-01
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| Series: | BMJ Global Health |
| Online Access: | https://gh.bmj.com/content/5/9/e002555.full |
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| author | Harkesh Dabas Beena E Thomas Sarah Helfinstein Mokshada Jain Hannah Kemp Sema K Sgaier Elisabeth Engl Gayathri Natarajan Prithivi Prakash Jayabal Lavanya Murugesan Jagadeesan Rebekah Chang Tichakunda Mangono Shamim Mannan Grace K Charles |
| author_facet | Harkesh Dabas Beena E Thomas Sarah Helfinstein Mokshada Jain Hannah Kemp Sema K Sgaier Elisabeth Engl Gayathri Natarajan Prithivi Prakash Jayabal Lavanya Murugesan Jagadeesan Rebekah Chang Tichakunda Mangono Shamim Mannan Grace K Charles |
| author_sort | Harkesh Dabas |
| collection | DOAJ |
| description | Introduction Delaying care-seeking for tuberculosis (TB) symptoms is a major contributor to mortality, leading to worse outcomes and spread. To reduce delays, it is essential to identify barriers to care-seeking and target populations most at risk of delaying. Previous work identifies barriers only in people within the health system, often long after initial care-seeking.Methods We conducted a community-based survey of 84 625 households in Chennai, India, to identify 1667 people with TB-indicative symptoms in 2018–2019. Cases were followed prospectively to observe care-seeking behaviour. We used a comprehensive survey to identify care-seeking drivers, then performed multivariate analyses to identify care-seeking predictors. To identify profiles of individuals most at risk to delay care-seeking, we segmented the sample using unsupervised clustering. We then estimated the per cent of the TB-diagnosed population in Chennai in each segment.Results Delayed care-seeking characteristics include smoking, drinking, being employed, preferring different facilities than the community, believing to be at lower risk of TB and believing TB is common. Respondents who reported fever or unintended weight loss were more likely to seek care. Clustering analysis revealed seven population segments differing in care-seeking, from a retired/unemployed/disabled cluster, where 70% promptly sought care, to a cluster of employed men who problem-drink and smoke, where only 42% did so. Modelling showed 54% of TB-diagnosed people who delay care-seeking might belong to the latter segment, which is most likely to acquire TB and least likely to promptly seek care.Conclusion Interventions to increase care-seeking should move from building general awareness to addressing treatment barriers such as lack of time and low-risk perception. Care-seeking interventions should address specific beliefs through a mix of educational, risk perception-targeting and social norms-based campaigns. Employed men who problem-drink and smoke are a prime target for interventions. Reducing delays in this group could dramatically reduce TB spread. |
| format | Article |
| id | doaj-art-47d2b57ae299472991170b45a7e3d5d4 |
| institution | Kabale University |
| issn | 2059-7908 |
| language | English |
| publishDate | 2020-09-01 |
| publisher | BMJ Publishing Group |
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| series | BMJ Global Health |
| spelling | doaj-art-47d2b57ae299472991170b45a7e3d5d42024-12-07T20:10:09ZengBMJ Publishing GroupBMJ Global Health2059-79082020-09-015910.1136/bmjgh-2020-002555Understanding why at-risk population segments do not seek care for tuberculosis: a precision public health approach in South IndiaHarkesh Dabas0Beena E Thomas1Sarah Helfinstein2Mokshada Jain3Hannah Kemp4Sema K Sgaier5Elisabeth Engl6Gayathri Natarajan7Prithivi Prakash8Jayabal Lavanya9Murugesan Jagadeesan10Rebekah Chang11Tichakunda Mangono12Shamim Mannan13Grace K Charles143 Clinton Health Access Initiative, Chennai/Delhi/NYC, India/USA2 Department of Social and Behavioral Research, National Institute for Research in Tuberculosis, Chennai, Tamil Nadu, India1 Surgo Foundation, Washington, DC, USA1 Surgo Foundation, Washington, DC, USASurgo Foundation, Washington, DC, USADepartment of Global Health and Population, Harvard University T.H. Chan School of Public Health, Boston, Massachusetts, USA1 Surgo Foundation, Washington, DC, USA3 Clinton Health Access Initiative, Chennai/Delhi/NYC, India/USA3 Clinton Health Access Initiative, Chennai/Delhi/NYC, India/USA4 District Tuberculosis Centre, Greater Chennai Corporation, Chennai, India5 Public Health Department, Greater Chennai Corporation, Chennai, India3 Clinton Health Access Initiative, Chennai/Delhi/NYC, India/USA1 Surgo Foundation, Washington, DC, USA3 Clinton Health Access Initiative, Chennai/Delhi/NYC, India/USA1 Surgo Ventures, Washington, DC, USAIntroduction Delaying care-seeking for tuberculosis (TB) symptoms is a major contributor to mortality, leading to worse outcomes and spread. To reduce delays, it is essential to identify barriers to care-seeking and target populations most at risk of delaying. Previous work identifies barriers only in people within the health system, often long after initial care-seeking.Methods We conducted a community-based survey of 84 625 households in Chennai, India, to identify 1667 people with TB-indicative symptoms in 2018–2019. Cases were followed prospectively to observe care-seeking behaviour. We used a comprehensive survey to identify care-seeking drivers, then performed multivariate analyses to identify care-seeking predictors. To identify profiles of individuals most at risk to delay care-seeking, we segmented the sample using unsupervised clustering. We then estimated the per cent of the TB-diagnosed population in Chennai in each segment.Results Delayed care-seeking characteristics include smoking, drinking, being employed, preferring different facilities than the community, believing to be at lower risk of TB and believing TB is common. Respondents who reported fever or unintended weight loss were more likely to seek care. Clustering analysis revealed seven population segments differing in care-seeking, from a retired/unemployed/disabled cluster, where 70% promptly sought care, to a cluster of employed men who problem-drink and smoke, where only 42% did so. Modelling showed 54% of TB-diagnosed people who delay care-seeking might belong to the latter segment, which is most likely to acquire TB and least likely to promptly seek care.Conclusion Interventions to increase care-seeking should move from building general awareness to addressing treatment barriers such as lack of time and low-risk perception. Care-seeking interventions should address specific beliefs through a mix of educational, risk perception-targeting and social norms-based campaigns. Employed men who problem-drink and smoke are a prime target for interventions. Reducing delays in this group could dramatically reduce TB spread.https://gh.bmj.com/content/5/9/e002555.full |
| spellingShingle | Harkesh Dabas Beena E Thomas Sarah Helfinstein Mokshada Jain Hannah Kemp Sema K Sgaier Elisabeth Engl Gayathri Natarajan Prithivi Prakash Jayabal Lavanya Murugesan Jagadeesan Rebekah Chang Tichakunda Mangono Shamim Mannan Grace K Charles Understanding why at-risk population segments do not seek care for tuberculosis: a precision public health approach in South India BMJ Global Health |
| title | Understanding why at-risk population segments do not seek care for tuberculosis: a precision public health approach in South India |
| title_full | Understanding why at-risk population segments do not seek care for tuberculosis: a precision public health approach in South India |
| title_fullStr | Understanding why at-risk population segments do not seek care for tuberculosis: a precision public health approach in South India |
| title_full_unstemmed | Understanding why at-risk population segments do not seek care for tuberculosis: a precision public health approach in South India |
| title_short | Understanding why at-risk population segments do not seek care for tuberculosis: a precision public health approach in South India |
| title_sort | understanding why at risk population segments do not seek care for tuberculosis a precision public health approach in south india |
| url | https://gh.bmj.com/content/5/9/e002555.full |
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