Multilevel Determinant of Delays Along the TB Care Pathway in Low and Middle-Income Countries: A Scoping Review

Sheila Puspitaningtyas (Public Health Faculty, Diponegoro University)
Zahroh Shaluhiyah (Faculty of Public Health, Diponegoro University)
Ratih Indraswari (Faculty of Public Health, Diponegoro University)

Journal of Educational, Health and Community Psychology
VOL 15 NO 3 SEPTEMBER 2026

Tuberculosis (TB) diagnostic delay remains a major challenge in low- and middle-income countries (LMICs). To map multilevel determinants of TB diagnostic delay across the TB care pathway in LMICs and identify the stages at which they contribute to delay. A scoping review was conducted using the Arksey and O’Malley framework. PubMed/MEDLINE, Scopus, ProQuest, and ScienceDirect were searched for English-language empirical studies published within the past five years. Determinants were categorized into individual, sociocultural, socioeconomic, and health system factors and mapped across four stages adapted from Scott et al.’s Model of Pathways to Treatment. 13 studies from seven LMICs were included. Individual and sociocultural determinants were prominent in the early stages, socioeconomic factors became more relevant at first consultation, while health system determinants were more prominent at diagnosis. TB diagnostic delay is a multilevel and stage-specific process, requiring integrated interventions across the TB care pathway.