Health Care Seeking Behavior in Individuals with tuberculosis Symptoms: A Comprehensive Study in Portugal

Abstract

Introduction Tuberculosis (TB) remains a leading global health issue, causing 1.3 million deaths in 2022, second only to COVID-19 among infectious diseases. The disease primarily affects the lungs and spreads through airborne droplets, with symptoms like persistent cough and fever often leading to delayed diagnosis. Despite progress, global TB incidence rose by 3.9% from 2020 to 2022, partly due to COVID-19 disruptions. Portugal, though a low-incidence country, faces challenges in early TB detection, with delays often worsening outcomes. This issue is particularly pressing in the Lisbon and Tagus Valley Region and the North Region, where incidence rates are highest. Understanding the healthcare-seeking behaviours of TB-positive patients is crucial to addressing these delays. This study explores the factors influencing whether individuals seek medical care promptly or delay, aiming to improve early diagnosis and tailor interventions to the specific needs of TB patients in Portugal. Objectives The study aims to compare the sociodemographic and health-related characteristics of individuals based on their decision to seek immediate medical care versus those who delay, while also identifying the factors that influence this critical choice. Additionally, it assesses how these delays affect the timing of TB diagnosis and the severity of symptoms at the time of diagnosis in Portugal. Methods This cross-sectional study targeted TB patients in Lisbon and Porto, Portugal, (YEAR) to identify factors contributing to delays in seeking healthcare. Recruitment occurred in primary care facilities with high TB notification rates, using a WHO-adapted questionnaire. The study included 114 participants, with data analyzed using descriptive statistics, including measures of central tendency (mean, median) and dispersion (standard deviation, range), as well as the Kruskal-Wallis test and Fisher exact test. Ethical approval was granted by regional health authorities, ensuring compliance with human rights and data protection regulations. Results The study sample had a mean age of 47.8 years, with 75.2% being male. Although not statistically significant, employed individuals (51.2% vs 19.8% unemployed) and those with higher education levels were more likely to seek medical care promptly. Those with higher incomes (≥1501 euros) tended to choose other options first. Symptoms significantly associated with seeking alternative care options included cough with sputum (p=0.003), persistent fever (p=0.013), weight loss (p=0.007), and asthenia (p=0.005). Notably, individuals reporting only one key symptom experienced the longest delays, averaging over 90 days before seeking medical attention. The mean time between symptom onset and first medical appointment was 57.43 days (SD=125.07), with no significant difference between those seeking prompt medical care and those delaying (p=0.273). The overall mean time from symptom onset to diagnosis was 108.95 days (SD=132.15), and from diagnosis to treatment start was 1.04 days (SD=12.6), with no significant differences between groups. Conclusion Our findings underscore the complex interplay of factors influencing TB care-seeking behavior in Portugal. The significant association between specific symptoms and delayed care-seeking emphasizes the critical need for public health education on symptom recognition and valorization. Particularly, the longer delays observed in individuals with single symptoms highlight a concerning trend of symptom underestimation. The unexpected patterns related to socioeconomic factors, such as higher income individuals choosing alternative care options, reveal unique aspects of the Portuguese healthcare context that warrant further investigation. Moreover, the lack of significant difference in diagnosis time between prompt and delayed care-seekers suggests potential healthcare system inefficiencies. The significant associations found between specific symptoms (such as cough with sputum, persistent fever, weight loss, and asthenia) and care-seeking behaviour emphasize the critical need for targeted public health education on symptom recognition. Particularly concerning is the trend of longer delays in individuals experiencing only one key symptom, indicating a potential underestimation of symptom severity. These results call for targeted interventions to improve early symptom recognition, address socioeconomic barriers to care, and enhance the efficiency of TB diagnostic processes in the Portuguese healthcare system. Future research should focus on developing and evaluating such interventions to reduce diagnostic delays and improve TB outcomes in Portugal.