Scrutinising delay in leprosy diagnosis in Colombia: perceptions and experiences by leprosy health professionals

Figures & data

Table 1. Participant demographics.

Variables		Number of participants (total = 9)
Sex	Male	2
	Female	7
Profession	Dermatologist leprosy programme	1
	General practitioner leprosy programme	2
	Local project leader leprosy programme	1
	Local project worker leprosy programme	1
	Medical Assessor leprosy-related NGO	1
	Representative leprosy-related NGO	2
	Social worker leprosy-related NGO	1
Department	Cesar and Valle del Cauca	4
	Cesar only	1
	Valle del Cauca only	4
Years of experience in Leprosy work	8–10	4
	11–20	3
	21–30	2

Figure 1. Reasons for diagnostic delay along the patient’s route to diagnosis according to leprosy health professionals in Cesar and Valle del Cauca.

Table 2. Recommendations to lower diagnostic delays in Cesar and Valle del Cauca based on our study.

Organise integral (specialised) leprosy care centres which are responsible for diagnosis, treatment, follow-up and contact tracing Organise a clear referral system to guide the patient from the general practitioner directly to an integral leprosy care centre Highlight the existence of leprosy and the importance of a timely referral for diagnosis in the medical curriculum to break with the current misconceptions among health staff that leprosy does not exist anymore in Colombia Carry out interventions aiming to increase leprosy awareness and reduce leprosy-related stigma among the general population, specifically in endemic areas and among lower socioeconomic populations Strengthen collaborations between committed parties and include patients’ perspectives to develop effective strategies (e.g. between the Ministry of Health and Social Protection and patient organisations)

Table

INTRODUCTION
- Interviewer introduces him/herself and the study. - Interviewer gives instructions about the interview. - Interviewer asks if participant has any questions about the interview/study. - (Interviewer is free to discuss any other topics/small talk to create trust.) - Informed consent: if written informed consent is not possible, verbal consent needs to be obtained and recorded.

Table

SEMI-STRUCTURED QUESTIONS
Introducing the participant	1. Could you briefly introduce yourself? How is your job related to Leprosy? It is not necessary to mention your name.
Exploring the route to diagnosis	2. In your own words, can you explain the patient’s route towards Leprosy diagnosis in Cesar/Valle del Cauca? Where do patients go when they experience Leprosy symptoms? Who establishes the diagnosis and how? What type of doctor?
Exploring the perception of delay in diagnosis	3. If we look at the patients who were diagnosed with Leprosy during this year and last year, how do you feel about the moment of diagnosis? Do you think there is a delay? Why do you think so? 4. What do you perceive as ‘delay’?
Exploring the reasons for delay in diagnosis	5. In previous studies, delay in diagnosis is explained as the time between noticing the first symptoms and getting diagnosed with Leprosy.In your opinion, what are the reasons for the delay in diagnosis? In your opinion, which reasons can you think of that cause Leprosy patients to not receive a Leprosy diagnosis immediately after they notice the first symptoms? Reasons related to people (e.g family, community, health worker) Reasons related to setting (e.g. access to the health system, resources/money, stigma, materials) 6. From your experience, which barriers do you experience in diagnosing Leprosy?7. Which barriers do you think patients experience to get a Leprosy diagnosis?8. A previous study conducted in Colombia (Gómez et al., 2018) showed that the majority of Leprosy patients do not seek help after noticing the first symptoms.What do you think about this? Do you think this is true/false? Why? (if yes) What do you think are the reasons that people do not seek help immediately? 9. In that same study, it was found that 27% of Leprosy patients need five or more consultations before they receive the Leprosy diagnosis.What do you think about this? Do you think this is true/false? Why? (if yes) What do you think are the reasons that patients need five or more consultations before receiving a Leprosy diagnosis? 10. Before moving on, are there any other reasons for delay in diagnosis that we have not discussed yet?
Exploring suggestions for improvement	11. In your opinion, what do you think is necessary to diminish the delay in diagnosing Leprosy? Why do you think so?

Table

ENDING

- These were my questions. Is there anything else related to the topic that we have not covered yet and that you would like to discuss? - How do you feel about the interview? Do you have any questions? - Thank you very much for your participation. May we contact you again in case additional questions come up? - Would you like to receive the results of the study once it is finished? (if yes) How can we reach out to you?

Gómez, L., Rivera, A., Vidal, Y., Bilbao, J., Kasang, C., Parisi, S., Schwienhorst-Stich, E. M., & Puchner, K. P. (2018). Factors associated with the delay of diagnosis of leprosy in north-eastern Colombia: a quantitative analysis. Tropical Medicine & International Health, 23(2), 193–198. https://doi.org/10.1111/tmi.13023

 PubMed Web of Science ®Google Scholar