Tuberculosis Knowledge, Perceived Stigma and Diagnostic Delay Intention among Residents of High-Density Urban Communities in Bangladesh

Tuberculosis remains a major public health concern when people postpone professional assessment after noticing possible symptoms. The relationship between perceived knowledge about TB, expected TB stigma, perceived benefits of early assessment, and access barriers with intention of delay in TB diagnosis was explored in this study. The 610 adults who participated in a cross-sectional survey were analysed using PLS-SEM. The indicator loadings, internal consistency, convergent and discriminant validity of the measurement model were good. Perceived TB knowledge decreased anticipated stigma and directly decreased intention of diagnostic delay and increased perceived benefits of early TB assessment. Intention to delay was greater for anticipated stigma and less for perceived access barriers, and greater for less perceived benefits of early assessment. The variance in the outcome variable, diagnostic delay intention, accounted for by the structural model was 33.7%. Perceived knowledge of TB also had a strong indirect effect on delay intention through anticipated stigma, suggesting that knowledge may affect delay not only directly but also indirectly by reducing the perceived stigma. Results indicate that the diagnostic delay intention can be influenced by both cognitive and social-practical mechanisms. Public health response should therefore centre on having clear information about TB, reducing stigma, improving the process of communication about the importance of seeking early care and action, and improving accessibility of TB services such as diagnostic services in dense urban settings.