Tuberculosis is a significant public health challenge in India, accounting for one-fourth of the global burden. Complex social, economic and behavioural factors among people affected by TB, combined with health system factors, shape care pathways and contribute to delays in TB care. Given this background, the study aimed to develop a constructivist grounded theory explaining how people affected by TB navigate care pathways and experience delays in two contrasting districts of Odisha. Adopting a constructivist grounded theory approach, the study was conducted in two high-burden districts of Odisha that represent demographically and geographically divergent contexts: Ganjam, a rural non-tribal district, and Mayurbhanj, a tribal-predominant district. The study participants included people affected by TB and their caregivers, as well as healthcare professionals involved in TB care. Sampling followed an initial purposive technique, with the final sample size guided by theoretical saturation. Data were collected through in-depth interviews, and analysis was iterative through constant comparison, developing co-constructed emergent categories and an explanatory framework. The main explanatory framework, “Fragmented care pathways in a layered TB care system”, explains how people affected by TB navigated a wide range of providers and experienced delays before their final entry into the TB programme. The framework is shaped by eight emergent categories: Circuitous entry to TB care, belief-mediated care, financial-mediated care, stigma-regulated care (representing the demand side), disease masking by provider, fragmented approach to TB care, trajectory of delayed care, and health system-mediated care (representing the supply side). The grounded theory underscores the need for redesigning the care pathways to address the fragmentation on the demand and supply side and moving beyond generalised to context-specific, tailored strategies to address delays in TB care and improve the care pathways. Not applicable.
Samal et al. (Fri,) studied this question.