Delay in seeking medical help in patients with Rheumatoid Arthritis in India: a qualitative study

Avinash Jain, Amita Aggarwal, Jo Adams, Rachel Jordan, Steven Sadhra, Shirish Dubey, Kerry Allen, Kanta Kumar

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Rheumatoid arthritis (RA) is an autoimmune disease with varied articular and extra-articular manifestations. In developing countries such as India patients with RA often delay seeking medical advice which may impact prognosis and disease burden.
To explore perceptions and experiences of patients living in India in seeking medical help for their RA symptoms.
Clinician diagnosed RA participants from different socio-economic backgrounds were interviewed using a semi-structured topic guide. Participants were purposively selected and interviewed following iterative approach. All interviews were recorded and transcribed by an independent company and analysed using thematic framework. Findings were reported in accordance with COREQ guidelines.
Twenty participants (13 male, 7 female) with median age 40 years [35.7- 46.5} were recruited. Three overarching themes demonstrating participants’ experiences and reasons for delay in seeking medical help were identified: [1] “Symptoms perspectives and delay in participants’ journey” narrated participants’ experiences of having RA symptoms, how these were perceived, rationalised and led to delay. [2] “Participants’ experience of the health care system” illustrated delay in referral, reaching diagnosis and treatment initiation highlighting their experiences with health system. [3] “Recommendations for improving care” where participants made recommendations for reducing the delay at local and national level.
This is the first qualitative study which explored perception and experiences of RA patients in India resulting in delay. Improved provision of rheumatology care, effective referral system and greater involvement of government at local and national levels are needed to improve the delay in seeking medical help for Indian patients.

Rheumatoid arthritis, Delay, Symptoms' perspectives, India, Healthcare
Original languageEnglish
Pages (from-to)1707-1718
JournalInternational Journal of Rheumatic Diseases
Issue number12
Early online date17 Oct 2020
Publication statusE-pub ahead of print - 17 Oct 2020


  • Delay, Symptoms
  • Healthcare
  • India
  • Rheumatoid arthritis
  • perspectives


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