title: Patient delay determinants for patients with suspected tuberculosis in Yogyakarta province, Indonesia.
abstract: OBJECTIVE
  Indonesia has a high incidence of tuberculosis (TB), despite the successful introduction of the directly observed treatment short-course strategy (DOTS strategy). DOTS depends on passive case finding. It is therefore important to identify determinants of patient delay and reasons for visiting a DOTS healthcare provider when seeking care. The aim of this study was to assess these determinants in TB suspects (coughing for at least 2 weeks).
  
  
  METHODS
  Cross-sectional data were gathered with a structured questionnaire in which psychosocial determinants were based on an extended version of the theory of planned behaviour (TPB). The study was conducted in five governmental lung clinics of Yogyakarta province. In total, 194 TB suspects that registered at the lung clinics were interviewed.
  
  
  RESULTS
  The median patient delay was 14 days (range 0-145). Ordinal regression analyses showed that visiting a private healthcare provider when first seeking health care, reporting travel distance/travel time as reason for choosing a certain healthcare provider when first seeking health care, discussing the symptoms with family and a reported short travel time, but no factors of TPB, were significantly associated with a shorter patient delay. An important factor negatively associated with visiting a DOTS clinic was the reported travel time.
  
  
  CONCLUSIONS
  Accessibility of the healthcare provider was the main determinant of patient delay, but the role of psychosocial factors cannot be fully excluded. Urban and suburban areas have relatively good access to (private) health care, hence the short delay. Thus, future studies should be focussed on extending the DOTS strategy to the private sector.
authors.affiliation: Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
authors.forename: Willem A
authors.initials: WA
authors.lastname: Lock
authors.forename: Riris A
authors.initials: RA
authors.lastname: Ahmad
authors.forename: Robert A C
authors.initials: RA
authors.lastname: Ruiter
authors.forename: Marieke J
authors.initials: MJ
authors.lastname: van der Werf
authors.forename: Arjan E R
authors.initials: AE
authors.lastname: Bos
authors.forename: Yodi
authors.initials: Y
authors.lastname: Mahendradhata
authors.forename: Sake J
authors.initials: SJ
authors.lastname: de Vlas
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D057210:Delayed Diagnosis / Q000706:statistics & numerical data*; D023801:Directly Observed Therapy / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D007214:Indonesia; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D017149:Private Sector; D017150:Public Sector; D012307:Risk Factors; D011795:Surveys and Questionnaires; D013997:Time Factors; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis*; D055815:Young Adult