title: Two vicious circles contributing to a diagnostic delay for tuberculosis patients in Arkhangelsk.
abstract: METHODS
  Delay in tuberculosis (TB) diagnosis increases the infectious pool in the community and the risk of development of resistance of mycobacteria, which results in an increased number of deaths.
  
  
  OBJECTIVE
  To describe patients' and doctors' perceptions of diagnostic delay in TB patients in the Arkhangelsk region and to develop a substantive model to better understand the mechanisms of how these delays are linked to each other.
  
  
  METHODS
  A grounded theory approach was used to study the phenomenon of diagnostic delay. Patients with TB diagnostic delay and doctors-phthisiatricians were interviewed.
  
  
  RESULTS
  A model named 'sickness trajectory in health-seeking behaviour among tuberculosis patients' was developed and included two core categories describing two vicious circles of diagnostic delay in patients with TB: 'limited awareness of the importance to contact the health system' and 'limited resources of the health system' and the categories: 'factors influencing health-seeking behaviour' and 'factors influencing the health system effectiveness'. Men were more likely to report patient delay, while women were more likely to report health system delay.
  
  
  CONCLUSIONS
  To involve people in early medical examinations, it is necessary to increase alertness on TB among patients and to improve health systems in the districts.
authors.affiliation: Institute of Health and Society, University of Oslo, Oslo, Norway; vnkuznetsov@gmail.com.
authors.forename: Vladimir N
authors.initials: VN
authors.lastname: Kuznetsov
authors.affiliation: Department of International Public Health, Norwegian Institute of Public Health, Oslo, Norway.
authors.forename: Andrej M
authors.initials: AM
authors.lastname: Grjibovski
authors.affiliation: Department of Tuberculosis, Northern State Medical University, Arkhangelsk, Russia.
authors.forename: Andrej O
authors.initials: AO
authors.lastname: Mariandyshev
authors.affiliation: Karolinska Institute, Stockholm, Sweden.
authors.forename: Eva
authors.initials: E
authors.lastname: Johansson
authors.affiliation: Institute of Health and Society, University of Oslo, Oslo, Norway.
authors.forename: Gunnar A
authors.initials: GA
authors.lastname: Bjune
mesh_terms: D000328:Adult; D000368:Aged; D057210:Delayed Diagnosis; D005260:Female; D017144:Focus Groups; D066296:Grounded Theory; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility / Q000458:organization & administration / Q000592:standards*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D036301:Qualitative Research; D012426:Russia; D014376:Tuberculosis / Q000175:diagnosis*; D055815:Young Adult
keywords: grounded theory; health system delay; patient delay; tuberculosis