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Free Content Help-seeking behavior of marginalized groups: a study of TB patients in Harlem, New York

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SETTING: Harlem Hospital Directly Observed Therapy (DOT) Program, New York City.

OBJECTIVE: To identify various pathways to tuberculosis (TB) diagnosis, and determine time to diagnosis and reasons for delay, to ensure rapid diagnosis of TB and prompt initiation of appropriate treatment.

DESIGN: Cross-sectional survey of the help-seeking behavior of TB patients within 2 months of their enrollment into DOT from May 2001 to December 2004.

RESULTS: The average total delay between symptom onset and a patient's diagnosis of TB was 18 weeks among 39 patients. The average delay to diagnosis attributed to patient delay and health care system delay were 10.5 and 7.5 weeks, respectively. Patients visited on average 1.6 sources of care prior to receiving a TB diagnosis. Foreign-born patients in particular were found to have more complex paths to diagnosis. The most common reason for delaying seeking care reported by patients was that they ‘didnĂ•t think it was serious’ (29.1%).

CONCLUSION: There was a substantial time interval between the onset of symptoms and TB diagnosis due to both patient and health care system delay. Foreign-born status, economic and social factors, and missed opportunities for diagnosis by the health care system played important roles in delaying TB diagnoses for the marginalized patients in this study.
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Keywords: delayed diagnosis; help seeking; marginalized groups; tuberculosis

Document Type: Regular Paper

Affiliations: 1: Charles P Felton National Tuberculosis Center, Harlem Hospital Center, New York, New York, USA 2: Charles P Felton National Tuberculosis Center, Harlem Hospital Center, New York, New York, USA; and Mailman School of Public Health, Columbia University, New York, New York, USA

Publication date: 2006-10-01

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  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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