A COM-B and Theoretical Domains Framework Mapping of the Barriers and Facilitators to Effective Communication and Help-Seeking Among People With, or Seeking a Diagnosis Of, Endometriosis

Summary & key facts

This qualitative study asked people with or seeking a diagnosis of endometriosis about their experiences talking with health professionals and asking for help. The researchers used interviews (4 people, ages 25–44) and an online survey (33 people, ages 20–48; 21 diagnosed, 12 seeking diagnosis). They found many communication barriers and some helpers, and mapped these to established behavior-change frameworks (COM-B and the Theoretical Domains Framework) to guide future interventions. The authors say targeting the key barriers could make it more likely that interventions change help-seeking and communication behavior.

Key facts:

• The study used semi-structured interviews with 4 women aged 25 to 44 and an online survey with 33 people aged 20 to 48.
• Of the 33 survey participants, 21 had a formal diagnosis of endometriosis and 12 were currently seeking a diagnosis.
• Researchers identified five COM-B domains that relate to communication and help-seeking: reflective motivation, social opportunity, physical opportunity, physical capability, and psychological capability.
• The analysis showed ten Theoretical Domains Framework (TDF) domains. Examples included concerns about dismissal by clinicians, feelings of disempowerment, social norms, beliefs about consequences, limited cognitive resources, reinforcement,
• This is the first study to map barriers and facilitators for endometriosis communication and help-seeking onto the COM-B and TDF frameworks to inform behavior-change intervention design.
• The paper is qualitative and exploratory. The total sample was small (4 interviewees and 33 survey respondents), so findings describe important themes but do not measure how common they are in the wider population.

Abstract

Endometriosis is a chronic condition in which tissue resembling the endometrium grows outside the womb, causing severe chronic pain. People with endometriosis report difficulty in help-seeking and communicating with healthcare professionals, contributing to diagnosis delays and ineffective management. The present study aimed to identify barriers and facilitators to effective communication using the Theoretical Domains Framework (TDF) and COM-B model to inform behavior change intervention development. This study was a qualitative semi-structured interview and open-ended survey design. Thematic Analysis was utilized to identify barriers and facilitators to effective communication which were mapped to the TDF and COM-B model. Four women aged 25 to 44 with a formal diagnosis of endometriosis participated in interviews. Thirty-three participants, aged 20-48 years, participated in the online survey, 21 of whom had a diagnosis of endometriosis (12 were currently seeking diagnosis). Five COM-B domains were identified: reflective motivation, social and physical opportunity, physical and psychological capability. Ten TDF domains were reflected in concerns surrounding dismissal, disempowerment, social norms, beliefs about consequences, cognitive resources, reinforcement, and environmental context and resources, among others. This is the first study to identify barriers and facilitators of effective communication and help-seeking in light of established behavioral change theory and frameworks for comprehensive intervention design. This provides a comprehensive explanation of challenges in help-seeking for endometriosis and represents the first step in the development of complex interventions to improve help-seeking and communication for people with endometriosis. Interventions targeting salient barriers will have greater potential to change behavior and improve outcomes.

Topics

Endometriosis Research and Treatment

Categories

Health Sciences Medicine Reproductive Medicine

Tags

Applied psychology Biology Context (archaeology) Endometriosis Gynecology Intervention (counseling) Medicine Nursing Paleontology Psychological intervention Psychology Qualitative research Social science Sociology Thematic analysis

Conditions & symptoms

Chronic Pain Chronic pain