title: Equality or equity in health care access: a qualitative study of doctors' explanations to a longer doctor's delay among female TB patients in Vietnam.
abstract: Earlier studies from Vietnam have highlighted the importance of studying gender aspects of health-seeking and diagnosis of potential tuberculosis patients. A longer doctor's delay to diagnosis among female TB patients has been shown. The objective of the present study was to explore doctors' views about and explanations for the longer doctor's delay. Five focus group discussions and three in-depth interviews were performed in a rural province in Vietnam. Thematic content analysis was used to interpret the data. The doctors suggest that women are lost or delayed within the health care-seeking chain, mainly because of barriers associated with the female gender. These barriers are identified, but yet the patient-doctor encounter seems to be steered by an equality principle. This results in gender blindness since equal treatment is suggested despite needs being different. We argue that gender equity should be the guiding principle for the tuberculosis patient-doctor encounter. An equity principle emphasises that needs vary with factors like gender or context. We suggest more research into the health care-seeking chain in order to identify the specific steps where TB diagnosis of men and women may be delayed. Interventions are needed in order to reduce delay to TB diagnosis especially for women and the current TB control strategy, (DOTS), needs to be examined from an equity perspective.
authors.affiliation: Division of International Health (IHCAR), Karolinska Institutet, 17176 Stockholm, Sweden. anna.thorson@phs.ki.se
authors.forename: A
authors.initials: A
authors.lastname: Thorson
authors.forename: E
authors.initials: E
authors.lastname: Johansson
mesh_terms: D001291:Attitude of Health Personnel / Q000208:ethnology; D005260:Female; D017144:Focus Groups; D005783:Gender Identity; D006297:Health Services Accessibility / Q000145:classification*; D006801:Humans; D008297:Male; D010342:Patient Acceptance of Health Care / Q000208:ethnology / Q000523:psychology*; D010817:Physician-Patient Relations; D036301:Qualitative Research; D012423:Rural Health; D012737:Sex Factors; D012959:Socioeconomic Factors; D013240:Stereotyping; D013997:Time Factors; D014376:Tuberculosis / Q000175:diagnosis* / Q000208:ethnology / Q000628:therapy; D014744:Vietnam; D016387:Women's Health / Q000208:ethnology