{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T22:13:03Z","timestamp":1779315183059,"version":"3.51.4"},"reference-count":84,"publisher":"MDPI AG","issue":"22","license":[{"start":{"date-parts":[[2021,11,12]],"date-time":"2021-11-12T00:00:00Z","timestamp":1636675200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003921","name":"Department of Health","doi-asserted-by":"publisher","award":["Department Order: 2020-0445"],"award-info":[{"award-number":["Department Order: 2020-0445"]}],"id":[{"id":"10.13039\/501100003921","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Identification of delay barriers to care is essential for an effective and efficient healthcare service delivery. In this study, we described the delay in care among parents of the patients seeking treatment for dengue. We also examined the factors affecting the severity of dengue (dengue with warning signs; severe dengue). A convergent parallel design mixed-method approach using Key Informant Interviews (KII) and a survey guided by the Three-Delay Model were conducted among 24 respondents at the National Children\u2019s Hospital (NCH). Coding and thematic analysis using NVIVO and bivariable generalized linear models with a Poisson distribution and robust variance were utilized to analyze the KII transcripts and survey data, respectively. Results showed that financial constraints and previous dengue infection (first delay), mode of transportation, traffic density, and location (second delay), and hospital capacity (third delay) influenced the overall delay uncertainty in seeking care treatment for dengue infection. Furthermore, our bivariable analysis showed that travel time to NCH and place of residency, service given from previous health facilities, and parents\u2019 educational background were associated and played a role in the severity of dengue infection. Interventions focused on the identified factors contributing to delayed care should be made to avoid unwanted clinical outcomes.<\/jats:p>","DOI":"10.3390\/ijerph182211851","type":"journal-article","created":{"date-parts":[[2021,11,12]],"date-time":"2021-11-12T08:10:22Z","timestamp":1636704622000},"page":"11851","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["\u201cWe Tried to Borrow Money, but No One Helped.\u201d Assessing the Three-Delay Model Factors Affecting the Healthcare Service Delivery among Dengue Patients during COVID-19 Surge in a Public Tertiary Hospital: A Convergent Parallel Mixed Methods Study"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7469-7670","authenticated-orcid":false,"given":"Antonio D.","family":"Ligsay","sequence":"first","affiliation":[{"name":"The Graduate School & College of Science, University of Santo Tomas, Manila 1008, Philippines"},{"name":"Clinical Research Section, St. Luke\u2019s College of Medicine-William H. Quasha Memorial, Quezon City 1112, Philippines"},{"name":"National Children\u2019s Hospital, New Manila, Quezon City 1113, Philippines"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maurice Lee B.","family":"Santos","sequence":"additional","affiliation":[{"name":"National Children\u2019s Hospital, New Manila, Quezon City 1113, Philippines"},{"name":"College of Nursing, Manila Tytana Colleges, Metropolitan Park, Pasay City 1300, Philippines"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Epifania S.","family":"Simbul","sequence":"additional","affiliation":[{"name":"National Children\u2019s Hospital, New Manila, Quezon City 1113, Philippines"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kristan Jela M.","family":"Tambio","sequence":"additional","affiliation":[{"name":"National Children\u2019s Hospital, New Manila, Quezon City 1113, Philippines"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michelle Joyce M.","family":"Aytona","sequence":"additional","affiliation":[{"name":"National Children\u2019s Hospital, New Manila, Quezon City 1113, Philippines"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4524-0385","authenticated-orcid":false,"given":"Grecebio Jonathan D.","family":"Alejandro","sequence":"additional","affiliation":[{"name":"The Graduate School & College of Science, University of Santo Tomas, Manila 1008, Philippines"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0665-5089","authenticated-orcid":false,"given":"Richard Edward L.","family":"Paul","sequence":"additional","affiliation":[{"name":"Functional Genetics of Infectious Diseases Unit, Institut Pasteur, UMR 2000 (CNRS), 75015 Paris, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3383-6336","authenticated-orcid":false,"given":"Zypher Jude G.","family":"Regencia","sequence":"additional","affiliation":[{"name":"Institute of Clinical Epidemiology, National Institutes of Health, University of the Philippines Manila, Ermita, Manila 1000, Philippines"},{"name":"Department of Clinical Epidemiology, College of Medicine, University of the Philippines Manila, Ermita, Manila 1000, Philippines"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3888-8880","authenticated-orcid":false,"given":"Emmanuel S.","family":"Baja","sequence":"additional","affiliation":[{"name":"Institute of Clinical Epidemiology, National Institutes of Health, University of the Philippines Manila, Ermita, Manila 1000, Philippines"},{"name":"Department of Clinical Epidemiology, College of Medicine, University of the Philippines Manila, Ermita, Manila 1000, Philippines"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2021,11,12]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"504","DOI":"10.1038\/nature12060","article-title":"The global distribution and burden of dengue","volume":"496","author":"Bhatt","year":"2013","journal-title":"Nature"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1016\/S0966-842X(01)02288-0","article-title":"Epidemic dengue\/dengue hemorrhagic fever as a public health, social and economic problem in the 21st century","volume":"10","author":"Gubler","year":"2002","journal-title":"Trends Microbiol."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Viennet, E., Ritchie, S.A., Williams, C.R., Faddy, H.M., and Harley, D. 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