Tuberculosis (TB) occurs as one of the highest in the state of Selangor, Malaysia and its causes are currently underexplored especially from patients' perspectives of the disease. This study assesses perspectives from patients in relations to determinants of delayed presentation, diagnosis, and treatment of TB. The study utilises a qualitative methodology involving focus group discussions and in-depth interviews with patients selected based on specific inclusion and exclusion criteria. The research covered components which include social demographic, sociocultural factors, health-seeking behaviors, social support and resources, previous knowledge and experience as a TB patient, and treatment pathway. Thematic analysis was performed using NVivo 12 analysis software to interpret the data. This study aims to identify key barriers and facilitators of prompt presentation and diagnosis of TB patients. Results revealed that socioeconomic status, challenges faced during TB diagnosis and treatment, knowledge of TB, patient and healthcare-related factors, and health-seeking behaviours were the main emerging themes. Improvements are required in the areas of access to healthcare facilities, minimizing cost, providing specific clinics and proximity of health facilities to facilitate a prompt response, increasing capacity to isolate infected persons, and provision of adequate treatment. It is revealed that financial constraints, inaccessibility and long distance to healthcare facilities, poor knowledge of TB, and lack of family and social support contributed to delayed TB presentation and diagnosis. Findings from this study can be utilized to develop effective, locally tailored interventions to address delayed presentation and diagnosis of TB patients in the nation.
The high prevalence rate and ever-increasing incidence of tuberculosis (TB) worldwide remain a significant issue in healthcare. In Malaysia, the incidence and mortality rate of TB is increasing due to the delayed presentation of TB patients to healthcare facilities. However, there is a lack of local studies on the contributing factors of delayed presentation of TB patients in Malaysia. This study aims to establish a social epidemiology framework by analysing social factors including socio-epidemiological, socio-cultural, and health-seeking behaviours associated with the delay in seeking TB treatment among patients in Selangor, Malaysia. A sequential exploratory mixed-method study design that combines qualitative and quantitative research methods will be employed. This study will recruit adult patients who have been diagnosed with TB using chest X-ray and sputum smear microscopy. Four districts with the highest recorded cases in the state of Selangor will be selected as study locations. The qualitative study will involve a Focus Group Discussion (FGD) to explore six components, namely demographic, socio-cultural, health-seeking behaviours, social support and resources, previous knowledge and experience with illness, and treatment pathway. Meanwhile, the quantitative study will incorporate a structured survey that will be developed based on the themes identified in the qualitative phase and a review of several studies in the literature. Several quality control measures will be taken while ensuring that the survey questionnaires are anonymised and participants' confidentiality is maintained. The data obtained from both qualitative and quantitative approaches will be combined to provide a more robust assessment of the study. Given that this study will focus on districts with high recorded cases of TB in Selangor, the findings might assist to address TB-related issues such as the increasing incidence and mortality rates, which are mainly attributed to the delayed presentation of TB patients to healthcare facilities.