A Model of Factors Predicting Delayed Access to Healthcare Services among People with Rheumatoid Arthritis: A Cross-Sectional Study

Abstract

Delayed access to healthcare services among people with rheumatoid arthritis remains a critical challenge, which may increase the risks of disability and reduce quality of life. Timely initiation of disease-modifying anti-rheumatic drugs within the first 12 weeks is the therapeutic window of opportunity essential for preventing long-term disease progression. However, evidence explaining the determinants of delayed access in Asian contexts remains limited. This study aimed to design and test a causal model of factors predicting delayed access to healthcare services among people who have rheumatoid arthritis in Northern Vietnam. A detailed cross-sectional study was conducted among 308 adults with rheumatoid arthritis between June and September 2023. Data were collected using the Demographic and Clinical Questionnaire, the Health Literacy Short Form-12 items (HL-SF12), the Brief Illness Perception Questionnaire (BIPQ), and the General Help-Seeking Questionnaire (GHSQ). Structural equation modeling was used to examine the relationships between variables and identify predictors of delayed access to care. Delayed access was highly prevalent, with 91% of participants experiencing delays of three months or longer before receiving treatment. The f inal model explained 9.6% of the variance in delayed access. Health literacy and help-seeking behaviors demonstrated small but statistically signif icant total effects in reducing delay. A strong negative relationship was observed between health literacy and help-seeking behaviors. The model’s limited explanatory power highlights the need to enhance its predictive capabilities by adding more factors or variables before further testing. Nursing interventions and practice should broaden strategies beyond individual behaviors to address structural, cultural, and service barriers, thereby improving equity and the timeliness of care.