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Nível de conhecimento e a demora na procura de cuidados de saúde em doentes com tuberculose pulmonar nas zonas urbanas de Portugal
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Introdução: A demora na procura de cuidados de saúde constitui um obstáculo relevante ao diagnóstico precoce e ao controlo de tuberculose, sobretudo em contextos urbanos. O nível de conhecimento dos doentes tem sido apontado como um potencial determinante na valorização dos sintomas e na decisão de procurar cuidados atempadamente. Objetivo: Analisar a associação entre o nível de conhecimento sobre tuberculose e a demora na procura de cuidados de saúde em doentes com tuberculose pulmonar residentes em zonas urbanas de Lisboa e Porto. Métodos: Estudo transversal com dados secundários de doentes diagnosticados entre 2019 e 2021 no projeto URBANTB. A demora foi definida como o intervalo superior a 21 dias entre o início dos sintomas e a primeira procura de cuidados de saúde. Realizaram se análises descritivas, bivariadas e multivariadas por regressão de Poisson com variância robusta. Foi posteriormente efetuada análise de sensibilidade com ponto de corte de 30 dias. Resultados: Foram incluídos 97 doentes na análise descritiva, dos quais 48 apresentavam informação completa para a análise multivariada. A mediana de demora foi de 22 dias, com 46,4% dos doentes a apresentarem demora superior a 21 dias. A maioria dos participantes apresentou conhecimento adequado sobre tuberculose (94,8%). O nível de conhecimento não apresentou associação significativa com a demora na procura de cuidados. Na análise multivariada, apenas a desvalorização dos sintomas se associou à demora, estando a sua ausência associada a menor prevalência de demora (RP ajustada = 0,51; IC95%: 0,30–0,89; p=0,02). Na análise de sensibilidade (>30 dias), nenhuma variável permaneceu estatisticamente significativa. Conclusão: A demora na procura de cuidados permanece frequente em contexto urbano. Os resultados sugerem que a desvalorização dos sintomas pode desempenhar um papel relevante na ocorrência de atraso, enquanto o conhecimento factual, isoladamente, pode não ser suficiente para promover a procura precoce de cuidados de saúde. Estratégias de intervenção devem focar-se na valorização dos sintomas e na perceção de risco, para além da simples transmissão de informação.
Introduction: Delay in seeking healthcare is a relevant barrier to early diagnosis and effective tuberculosis control, particularly in urban settings. Patients’ level of knowledge has been identified as a potential determinant of symptom appraisal and timely care seeking behaviour. Objective: To analyse the association between the level of knowledge about tuberculosis and delay in seeking healthcare among patients with pulmonary tuberculosis living in urban areas of Lisbon and Porto. Methods: A cross-sectional study was conducted using secondary data from patients diagnosed between 2019 and 2021 within the URBANTB project. Delay was defined as an interval greater than 21 days between symptom onset and the first healthcare contact. Descriptive, bivariate and multivariable analyses were performed using Poisson regression with robust variance. A sensitivity analysis using a 30-day cut-off was also conducted. Results: A total of 97 patients were included in the descriptive analysis, of whom 48 had complete data for multivariable analysis. The median delay was 22 days, with 46.4% of patients presenting a delay greater than 21 days. Most participants had adequate knowledge about tuberculosis (94.8%). Knowledge level was not significantly associated with delay in seeking healthcare. In the multivariable analysis, only symptom devaluation was associated with delay, with the absence of symptom devaluation being associated with a lower prevalence of delay (adjusted PR = 0.51; 95% CI: 0.30–0.89; p=0.02). In the sensitivity analysis (>30 days), no variables remained statistically significant. Conclusion: Delay in seeking healthcare remains frequent in urban settings. The findings suggest that symptom devaluation may play an important role in delayed care seeking, while factual knowledge alone may not be sufficient to promote timely healthcare utilisation. Interventions should focus on improving symptom appraisal and risk perception, beyond the mere provision of information.
Introduction: Delay in seeking healthcare is a relevant barrier to early diagnosis and effective tuberculosis control, particularly in urban settings. Patients’ level of knowledge has been identified as a potential determinant of symptom appraisal and timely care seeking behaviour. Objective: To analyse the association between the level of knowledge about tuberculosis and delay in seeking healthcare among patients with pulmonary tuberculosis living in urban areas of Lisbon and Porto. Methods: A cross-sectional study was conducted using secondary data from patients diagnosed between 2019 and 2021 within the URBANTB project. Delay was defined as an interval greater than 21 days between symptom onset and the first healthcare contact. Descriptive, bivariate and multivariable analyses were performed using Poisson regression with robust variance. A sensitivity analysis using a 30-day cut-off was also conducted. Results: A total of 97 patients were included in the descriptive analysis, of whom 48 had complete data for multivariable analysis. The median delay was 22 days, with 46.4% of patients presenting a delay greater than 21 days. Most participants had adequate knowledge about tuberculosis (94.8%). Knowledge level was not significantly associated with delay in seeking healthcare. In the multivariable analysis, only symptom devaluation was associated with delay, with the absence of symptom devaluation being associated with a lower prevalence of delay (adjusted PR = 0.51; 95% CI: 0.30–0.89; p=0.02). In the sensitivity analysis (>30 days), no variables remained statistically significant. Conclusion: Delay in seeking healthcare remains frequent in urban settings. The findings suggest that symptom devaluation may play an important role in delayed care seeking, while factual knowledge alone may not be sufficient to promote timely healthcare utilisation. Interventions should focus on improving symptom appraisal and risk perception, beyond the mere provision of information.
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Tuberculose Demora no diagnóstico Procura de cuidados de saúde Valorização dos sintomas Tuberculosis Diagnostic delay Healthcare-seeking behaviour Symptom appraisal