ABSTRACT
Background: Little information is available on triggers and barriers for seeking appropriate healthcare among chest symptomatics (CS) from slum populations in India. Methods: Urban slums in Uttar Pradesh (UP) and Karnataka (KA) were selected based on case detection rate (2008), population size and geographic distribution. A door-to-door survey was conducted in 2010 and CS were identified and interviewed. Action taking patterns were collected and factors influencing these among behavers (CS visiting qualified providers) and non-behavers (CS not taking action or resorting to self-medication) compared. Results: Of 1526 CS in UP and 1515 in KA interviewed, 75% in UP and 58% in KA sought care; of them 79% in UP and 99% in KA visited a qualified provider. More than 80% in both UP and KA underwent recommended tests within a week (mean days: UP-1.8; KA-2.4). Only 16% of respondents in UP and 48% in KA reported that private qualified providers recommended sputum microscopy. Important triggers of visiting a qualified provider were being females; of higher economic status, self-efficacy, suspicion of having TB when suffering from persistent cough and that sputum microscopy should be done to diagnose TB. Additional triggers included knowledge that TB is caused by germs and can affect anyone (UP) and perceptions of quality of care and knowledge that TB is curable (KA). Implications: There is need to carry out targeted area-specific communication in slums to improve appropriate treatmentseeking behaviour and demand creation for DOTS by CS. The study recommends investments to focus on changing private provider behaviour.