Understanding healthcare pathways of patients with chronic respiratory disease: insights from an exploratory study in a government sub-district hospital of Bangladesh

Abstract

Introduction: Chronic respiratory diseases (CRD) comprise a major burden of public health, especially in low-resource settings like rural Bangladesh. Many systemic, sociocultural and structural factors influence the care seeking journey of CRD patients, impact outcomes. There is an urgent need to understand the patient pathways for seeking CRD care in order to address the gaps in service delivery and to meet the unique needs of CRD patients. Method: The study adopted a qualitative exploratory approach to elicit relevant data from the CRD patients. A total 20 respondents were sampled conveniently and interviewed to explore symptoms, onset of illness, self-management practices, healthcare seeking journey including choice and decision to choose service delivery points, experiences at each care point, and the overall impact on health and financial conditions. Data analysis involved both quantitative and qualitative methods, utilizing STATA V17 for descriptive statistics and thematic analysis for qualitative data. Ethical clearance was obtained, ensuring informed consent and confidentiality for all participants. Findings: Respondents with CRD reported diverse care pathways, involving both formal and informal healthcare providers. The length of these pathways ranged from a single point of care to as many as five. Many participants delayed seeking treatment, often due to misattributing symptoms, underestimating their severity, or relying on beliefs about CRD that led them to manage symptoms with home remedies. Though the private providers and drug sellers were the most common initial points of care, while Upazila Health Complex (UHC) ultimately became the source of consistent care provider for most respondents due to their affordability and accessibility. Although the majority of respondents expressed satisfaction with UHC services , several challenges such as unavailability of essential medicines, lack of diagnostic facilities, shortened consultation times, disrespectful behavior from staff and insufficient privacy affected their overall experience. Receiving a CRD diagnosis often caused respondents to experience significant anxiety and worry, perceiving it as a lifelong burden. Moreover, the financial stress was another major concern and there were patients who relied on family or borrowing to cover treatment costs. The combination of prolonged illness and economic hardship exacerbated feelings of anxiety, hopelessness and despair. Conclusion: Patients with CRD often use multiple pathways for various reasons to access various categories of providers before reaching UHC. This complex and challenging journey in accessing and using healthcare services, leading to delays in receiving proper formal care. Even though, UHC, a primary health care point, is not yet fully equipped to deliver high-quality CRD services, it remains a more accessible and affordable option for CRD patients, particularly those from poor, rural, and socioeconomically disadvantaged backgrounds. Addressing the underlying factors highlighted in the study can be useful for planning interventions to improve access to CRD care. Our findings aim to inform policymakers and guide program planning to enhance awareness, accessibility, and affordability of healthcare for CRD patients, thereby improving NCD care in Bangladesh.