Delay Seeking Help Research Articles

The impact of caregiver familiarity with mental disorders on timing of intervention in first‐episode psychosis

Based on prior research, we hypothesized that personal or family familiarity with psychosis would have a different effect on pathways to care as compared to personal or family familiarity with mental disorders. Caregivers of 32 patients receiving treatment for a first episode of psychosis at a specialized early intervention centre provided information regarding their familiarity with psychosis and mental disorders. Information on the duration of untreated psychosis (DUP) and on the duration of untreated illness (DUI) was collected from patients and their caregivers. Although we found a trend in the direction of lowered DUP and longer DUI for those with personal or family familiarity with psychosis, these effects were not statistically significant. A trend was found for a higher DUI for those with personal or family familiarity with mental disorders in general, but this effect was not significant. We did not find that differential familiarity with mental disorders and by extension, personal or family familiarity, affected measures of delay in treatment of a first episode of psychosis. Trends in our findings in the hypothesized directions suggest that a larger sample size may reveal significant differential effects of previous experience with mental disorders in general and psychosis in particular on delay in help seeking during different phases of the illness.

Gender bias and help seeking in coronary artery disease

Coronary artery Disease (CAD) is one of the leading causes of death in both men and women worldwide. Despite the common misconception that CAD is a ‘man's disease’ it is now well known that women endure much worse clinical outcomes than men following CAD-related events. A number of studies have explored whether gender differences exist in patients presenting with CAD, and specifically whether women do indeed delay seeking help for cardiac conditions. Understanding the difference between help-seeking decisions made by men and women is complex. Many UK and overseas studies suggest that women with cardiac symptoms often delay help seeking or making help-seeking decisions, but more work is needed. Women may not present with the same ‘classical’ chest pain symptoms but this should no means imply a low risk of CAD.

Sociodemographic Predictors of Recall and Recognition of Colorectal Cancer Symptoms and Anticipated Delay in Help-Seeking in a Multiethnic Asian Population

Colorectal cancer is the second most common cancer in Malaysia. The prognosis of the disease is excellent if detected at an early stage, but the majority of Malaysian patients present at late stages. We aimed to assess the awareness of cancer warning signs and anticipated delay in help-seeking as possible contributors to this phenomenon. A population-based cross-sectional survey using the Colorectal Cancer Awareness Measure was initiated in Perak, Malaysia. A total of 2,379 respondents aged 18 years and above were recruited using a multi-stage sampling in five locations. Analysis of covariance was used to examine independent sociodemographic predictors of scores for symptom awareness. Younger age, being female, a higher education, and higher income were significantly associated with better scores for both recall and recognition of warning symptoms. Among the ethnic groups, Malays had better recognition of symptoms whereas Chinese recalled the most symptoms. Passing bloody stool was associated with the least anticipated delay and unexplained anal pain had the highest anticipated delay. The level of awareness across all ethnicities in Malaysia is generally low, especially among minorities. Targeted public education, which is culturally and linguistically appropriate, should be developed to encourage early help-seeking and improve clinical outcomes.

Shedding light on women's help seeking behaviour for self discovered breast symptoms

PurposeTo describe women's help seeking behaviour (HSB) and the associated influencing factors on self-discovery of a breast symptom. MethodsA descriptive, correlational survey design was used. Following ethical approval, survey data were collected from women (n = 449) attending the breast clinics of two large urban hospitals within the Republic of Ireland. ResultsThe majority of women (69.9%; n = 314) sought help (by visiting their General practitioner, GP) within one month, 30.1% (n = 135) delayed help seeking for more than one month following symptom discovery and 16.7% (n = 75) delayed for three months or more. The factors most significantly associated with delayed HSB were knowledge around symptom identity (Odds Ratio (OR) = 4.80, p = 0.005); ignoring the symptom and hoping it would go away (OR = 10.72, p < 0.001) and women's belief that the symptom would persist for a long time (OR = 1.18, p = 0.023). Being afraid on symptom discovery (OR = 0.37, p = 0.005) was associated with reduced risk of delayed HSB. ConclusionsIt is encouraging to see that the majority of women who find a breast symptom seek help promptly. However, a small cohort of women delay seeking help from their GP. HSB is influenced by multiple factors which can impact on patient outcomes. Findings are important for oncology nurses who have a key role to play in promoting breast awareness, prompt help seeking and early detection and treatment of breast cancer, amongst women.

UK extended Medical Assessment Programme for ex-service personnel: the first 150 individuals seen

Aims and methodTo describe an interim service set up to examine the breadth of UK ex-service personnel's concerns in relation to their mental health and military service and provide a record of the first 150 individuals assessed following conformation of military service and examination of all available military and civilian medical records.ResultsThe majority of attendees were White male ex-soldiers. Average age, service and time to assessment were 44.5, 15.8 and 11.7 years respectively. Two-thirds were receiving help from the National Health Service and ex-service nongovernmental organisations. Rates of post-traumatic stress disorder were similar to previous UK studies. Obsessional symptoms were of relevance to the clinical presentation in a third. Fabrication and/or exaggeration occurred in about 10%.Clinical implicationsThe spread of diagnoses and delay in help-seeking are similar to civilians. The link between mental disorders and military service is seldom straightforward and fabrication or exaggeration is difficult for civilians to recognise. Verification and contextualisation of service using contemporaneous service medical records is important given the possible occupational origin of mental health conditions.

Beliefs About Breast Cancer and Help-Seeking Intentions for the Disease Among Women in India

Breast cancer is the most frequently occurring malignancy among women in India, however, the recorded stage distribution at presentation in India is less favorable than in Europe. Health beliefs are important in help-seeking for potential symptoms of disease, which may be particularly important among women who do not have access to breast screening programs. The purpose of this study was to examine Indian women's beliefs about breast cancer and help-seeking for the disease and how these beliefs related to their intentions to seek help for a symptom of breast cancer. Furthermore, the study aimed to examine differences in the beliefs of urban- and rural-based women. Of 800 women, 685 were recruited in Allahabad in Northern India (response rate 86%). The women completed a questionnaire examining beliefs about breast cancer and help-seeking. One in four women reported that they would delay seeking help for at least one month following the discovery of a symptom of breast cancer. Rural respondents held more negative beliefs about breast cancer and were also more likely to report less positive attitudes toward help-seeking and a belief that they would be discouraged from seeking help. The findings of the study provide suggestions for the targeting of an intervention aimed at improving early detection and help-seeking for breast cancer symptoms. This may be of particular importance in India where a breast cancer screening program does not currently exist and is being debated.

How to Reduce the Impact of “Low-Risk Patients” Following a Bioterrorist Incident: Lessons from SARS, Anthrax, and Pneumonic Plague

A bioterrorist attack may result in a large number of people who have not been exposed coming to medical facilities in search of treatment or reassurance. In this article, we review evidence from 3 previous biological incidents that are analogous to a bioterrorist attack in order to gauge the likely incidence of such "low-risk patients" and to identify possible strategies for coping with this phenomenon. Evidence from the anthrax attacks in the United States suggested that a surge of low-risk patients is by no means inevitable. Data from the SARS outbreak illustrated that if hospitals are seen as sources of contagion, many patients with non-bioterrorism-related healthcare needs may delay seeking help. Finally, the events surrounding the pneumonic plague outbreak of 1994 in Surat, India, highlighted the need for the public to be kept adequately informed about an incident. Although it is impossible to say what the likely incidence of low-risk patients will be during a future bioterrorist incident, several strategies may help to reduce it and to safeguard the well-being of the low-risk patients themselves. These strategies include providing clear information about who should and should not attend hospital; using telephone services to provide more detailed information and initial screening; employing rapid triage at hospital entrances, based, where possible, on exposure history and objective signs of illness; and following up by telephone those judged to be at low risk.

Awareness of cancer symptoms and anticipated help seeking among ethnic minority groups in England

Objective:Little is known about ethnic differences in awareness of cancer-warning signs or help-seeking behaviour in Britain. As part of the National Awareness and Early Diagnosis Initiative (NAEDI), this study aimed to explore these factors as possible contributors to delay in cancer diagnosis.Methods:We used quota sampling to recruit 1500 men and women from the six largest minority ethnic groups in England (Indian, Pakistani, Bangladeshi, Caribbean, African and Chinese). In face-to-face interviews, participants completed the newly developed cancer awareness measure (CAM), which includes questions about warning signs for cancer, speed of consultation for possible cancer symptoms and barriers to help seeking.Results:Awareness of warning signs was low across all ethnic groups, especially using the open-ended (recall) question format, with lowest awareness in the African group. Women identified more emotional barriers and men more practical barriers to help seeking, with considerable ethnic variation. Anticipated delay in help seeking was higher in individuals who identified fewer warning signs and more barriers.Conclusions:The study suggests the need for culturally sensitive, community-based interventions to raise awareness and encourage early presentation.

“Getting on with it”: Women's Experiences of Coping with Urinary Tract Problems

This study investigates women's experiences of symptoms, methods of coping, and patterns of interaction with health care providers in relation to urinary tract problems. Semi-structured interviews were carried out with 20 women (aged 50–79 years) who had recently been referred by their general practitioners (GPs) to a urology unit. Transcripts were subjected to Interpretive Phenomenological Analysis. Analysis revealed that although women encouraged family members to seek medical help at an early stage, they delayed seeking help for their own urinary tract problems for long periods of time, using a variety of self-help methods to treat, control, and hide symptoms. Delays in help seeking were due to women's belief that symptoms were a natural sign of aging, the acceptability of pads to hide leakage and women's confidence in self treatment. Medical help was only sought when they could no longer cope with symptoms. The quality of the relationship women had with their GP emerged as an important factor in encouraging self referral.

“Why doesn't she seek help for partner abuse?” An exploratory study with South Asian immigrant women

This study explores why South Asian immigrant women with experiences of partner abuse delay seeking help from professionals. Three focus groups were conducted in Hindi language with South Asian immigrant women in Toronto. Twenty-two women participated with a mean age of 46 years (range 29-68 years). Thematic analysis was conducted on the transcribed data using constant comparison techniques within and across the groups. We found that three major themes emerged from the discussions: reasons for delayed help-seeking, turning points and talking to professionals. Women expressed delaying help-seeking to the point when "Pani sar se guzar jata he" (water crosses over your head). Their dominant reasons for delayed help-seeking were social stigma, rigid gender roles, marriage obligations, expected silence, loss of social support after migration and limited knowledge about available resources and myths about partner abuse. Women usually turned for help only after experiencing pronounced mental and physical health problems. The findings are interpreted in light of participants' immigration context and the socio-cultural norms of patriarchy, collectivism and familism. Prevention approaches to address partner abuse and delayed help-seeking among South Asian immigrant women should include tailored community education, social services to reduce vulnerability, and cultural competency of professionals. Further research and program evaluation is needed to advance the field.

Before the consultation: why people do (or do not) go to the doctor

In 1973, Irving Zola published a classic paper on a problem that he suggested: ‘… we think we know a great deal about but that, in reality, we know so little — how and why an individual seeks professional medical aid.’ 1 Zola thought researchers made at least three assumptions about how and why a patient might appear in the consultation room and, in his view, none of them were justified. First, researchers assumed that patients are straightforwardly asymptomatic for most periods of their lives; second that, when patients do appear in the surgery, it is the seriousness and frequency of symptoms that prompt the visit to the doctor; and third that, when faced with such symptoms, patients who do not seek help are irrational. By contrast, Zola posited that most people have symptoms of something most of the time; that the frequency and/or seriousness of symptoms are not good predictors of attendance at the doctor; and that most people make decisions to seek (or delay seeking) help that are rational, at least if framed in terms of their own beliefs and values. In the last 30 years, considerable attention has been paid to these issues and, in particular, to interrogating the assumptions that Zola identified. This issue of the Journal contains two contributions to this literature, the first concerned with how women manage urinary tract infection2 and the reasons that prompt their …

Barriers and Triggers to Seeking Help for Potentially Malignant Oral Symptoms: Implications for Interventions

The detection of oral cancer at an early stage is the most effective means to improve survival and reduce morbidity However, approximately 30 percent of patients delay seeking help for more than 3 months following the self-discovery of symptoms of oral cancer. This study aimed to increase our understanding of patient delay to inform the development of interventions to encourage early presentation of oral cancer. Newly referred patients (n = 57) with potentially malignant oral symptoms were interviewed to determine influences on the timing of their decision to seek help. "Framework analysis" was used to analyze transcripts from semi-structured interviews. Barriers to seeking help related to beliefs about symptoms, the health care professional (HCP), and an individual's circumstances. The main triggers to seeking help included the symptomatology and the presence of another reason for visiting an HCP CONCLUSIONS: The results are discussed with reference to their implications for interventions aimed at reducing patient delay.

Breast cancer awareness among older women

The aim of this study was to elicit the level of breast cancer awareness in older women. A cross-sectional study-specific questionnaire survey of 712 British women aged 67–73 years (response rate 83.8%), assessing knowledge of symptoms and risk and confidence to detect a change, was conducted. Over 85% of respondents were aware that a lump was a symptom of breast cancer but knowledge of non-lump symptoms was limited. Knowledge of risk was poor; 50% believed that the lifetime risk of developing breast cancer was less than 1 in 100 women and 75% were not aware that age is a risk factor. Thirty-one percent of women reported low levels of confidence to detect a breast change and 19% rarely or never checked their breasts. Those with fewer educational qualifications had poorer knowledge of symptoms, less awareness of lifetime and age-related risks, but were more likely to check their breasts than more highly educated women. This national survey demonstrates a significant lack of the prerequisite knowledge and confidence to detect a breast change. Raising breast cancer awareness and promoting early presentation among older women is important, as they are more at risk of breast cancer and more likely to delay seeking help with breast cancer symptoms than younger women.

Asian American Cancer Patients' Pain Experience

Asians have been reported to rarely complain about pain and to delay seeking help until pain becomes severe. Even in Asian countries, cancer pain has been reported to be underestimated and inadequately managed. Despite these findings, very little is still known about Asian American cancer patients' pain experience. The purpose of this study was to explore Asian American cancer patients' pain experience using a 6-month online forum among 27 Asian American cancer patients. Nine online forum topics on cancer pain experience were used for the data collection. The data were analyzed using thematic analysis. Three themes emerged through the data analysis process: (a) "pain is a natural thing," (b) "keep things as usual," and (c) "mind is over body." Asian American cancer patients considered pain as their bodies' spontaneous reactions to cancer that could not be avoided. They believed that it was very important to keep things as usual so that they could have a sense of being normal again. The participants thought that cancer and pain could be overcome through positive thinking. The findings suggest more in-depth cultural studies on pain experience among diverse subethnic groups of Asian American cancer patients.

Coping mechanisms in women living with pelvic floor dysfunction

Purpose: Pelvic floor dysfunction (PFD) encompasses symptoms that include urinary and faecal incontinence, obstructed defaecation and pelvic organ prolapse. It impacts on the quality of life of women, and is associated with stigma, embarrassment, and a delay in seeking help. Nurses often see women in clinics who have both colorectal and urinary symptoms, many of whom have delayed seeking help. Aim: To understand the coping mechanisms women develop and the triggers which prompt seeking help. Methodology: Micro−ethnography focusing on the emic (personal worldview) perspective of women with PFD. Findings: Ten themes relating to coping and help seeking have emerged. These are: knowledge; health care beliefs; coping mechanisms; perception of severity of the problem; role obligations; emotions; locus of control; trigger events; financial implications; and personality. Subsequently, specific tools for use in exploring coping and help seeking have been developed.

Patient delay for potentially malignant oral symptoms

The detection of oral cancer at an early stage is the most effective means to improve survival and reduce morbidity, disfigurement, duration of treatment, and hospital costs associated with this disease. However, approximately 30% of patients delay seeking help for more than 3 months following the self-discovery of symptoms of oral cancer. This study aimed to increase our understanding of patient delay for potentially malignant oral symptoms in order to inform the development of interventions to encourage early presentation of oral cancer. Newly referred patients (n = 80) with potentially malignant oral symptoms completed a questionnaire to determine influences on the timing of their decision to seek help. Logistic regression analyses were conducted to determine factors associated with patient delay. The analysis indicated that the gravity of patients' initial symptom interpretation, the level of deprivation, knowledge of oral cancer, severity of life events in the patient delay period, and perceived ability to seek help for oral symptoms were significantly related to the duration of patient delay, with the latter three variables being independent predictors. The results are discussed with reference to their implications for interventions aimed at reducing patient delay for symptoms of oral cancer.

Women’s help-seeking behaviour at the onset of myocardial infarction

Few studies have explored the factors affecting women's decisions to seek medical assistance at the onset of cardiac symptoms. Although some studies have shown that there are gender differences between men and women in terms of how they cope with having a myocardial infarction (MI) and heart disease, few have explored how women actually experience MI and what influences their help-seeking behaviour. Those studies that have, suggest that women often fail to recognize the signs of MI and delay seeking treatment for symptoms of MI longer than men do. This qualitative study explores the female experience of MI, focusing on some of the thought processes and coping strategies used by women when having an MI. Using a grounded theory research approach, 25 post-MI female patients were interviewed about their experiences during acute MI. Through analysing and coding data, a number of categories emerged that provide insight into the health seeking behaviour of women at the onset of MI. Emergent categories were: a delay in seeking help (main category); an engendered perception of heart disease (sub-category); not recognizing symptoms (sub-category); maintaining control through self-medication (sub-category). Analysis of the data suggests that when experiencing an MI, women delay seeking help for a number of reasons, including not recognizing symptoms, perceiving heart disease as a 'male' problem and preferring to self-medicate.

Patient Decision Making in Prehospital Health Emergencies: Determinants and Predictors of Patient Delay

Background Previous research has identified that cardiac patients tend to delay seeking help for chest pain. This study examined whether help-seeking delay occurred in all health emergencies, and explored what people are doing while they delay. This study also explored patient decision making processes and behaviours that determine how long it takes patients to seek emergency help. Methods This study used a self administered survey, including the Coping Responses Inventory. Participants were a random sample of emergency department attendees, stratified for urgency (high vs medium–low) and mode of transport to the hospital emergency department (ambulance vs other). Additional in-depth patient interviews were also conducted. Results Survey responses showed the median delay from symptom onset to arrival at health care was 4.6 hours. Discriminant Function Analysis identified that gender, pain and coping style predicted delay. Conclusion This study identified that delay is not unique to cardiac emergencies. A process of decision making was undertaken which was common to many health emergencies involving a conscious patient, the outcome of which determined how long each patient took to seek help. Psychosocial, normative and affective factors such as coping style drove patient decisions during a health emergency. The knowledge that patients make decisions in a health emergency based on what they feel, not on what they know is a breakthrough in the understanding of patient motivations to seek medical help in health emergencies, and may explain why traditional patient education using an informative approach has had only limited success.

‘It was not chest pain really, I can't explain it!’ An exploratory study on the nature of symptoms experienced by women during their myocardial infarction

This study sought to explore the presenting nature of cardiac symptoms as experienced by women diagnosed with a myocardial infarction. The objectives were to use the participants' own words to gain a detailed understanding of how they perceived their evolving symptoms. Women with coronary heart disease tend to delay seeking help despite experiencing symptoms. The classic hallmarks used to diagnose a myocardial infarction have been based on research primarily involving white middle-aged men with a focus on specific descriptions of chest pain. Whether these hallmarks apply to women in the same way as they apply to men is an area of increasing contention. Using a purposive sample, a qualitative design was used to investigate the nature of cardiac symptoms experienced by women prior to and at the time of their myocardial infarction. Twelve women participated in semi-structured in-depth tape-recorded interviews conducted while they were in hospital. Three interlinking themes emerged, which reflect a changing dynamic status in health, mediated by the perceived threat of individual symptoms. These included gradual awareness, not having pain in the chest and reactions to symptoms. It would appear that symptom presentation and distribution amongst women may not follow the pattern traditionally associated with current understanding of a 'typical' myocardial infarction. These differences together with perceptions about their cardiac symptoms may influence their health-seeking behaviours. Women with a myocardial infarction may present with non-specific chest symptoms, which are difficult to interpret or recognize by patients and health professionals alike. Skill in recording history and in performing a comprehensive assessment of initial and current symptoms will enable nurses to identify women with a differential diagnosis of chest pain readily. Additionally, to increase awareness of coronary heart disease, nurses must use any opportunity to educate women of all age groups.

Decision-making about seeking medical advice in an internet sample of women trying to get pregnant

In light of the near universal desire to become a parent one would expect most people to seek medical advice if they were experiencing difficulties conceiving. Yet less than 55% do so and we sought to understand more about this paradox by comparing the psychosocial profile and decision-making of women not yet engaged in the medical process to that of those who had consulted. A Fertility Decision-Making Questionnaire was designed and posted on a website dedicated to women trying to conceive. A total of 426 women completed the questionnaire, 56% had not yet consulted a doctor about conceiving (non-consulter, NC). Women who had sought treatment had more positive treatment beliefs, and a greater willingness to know if a problem existed, than those who had not yet consulted. Almost 20% of NC women already met the medical definition of infertility and this subgroup had a greater fear of discovering a problem and of being labelled infertile than other women in the study. Seeking medical advice for fertility problems is mainly associated with what women know or want to know about their fertility and their emotional reactions to that knowledge. Negative reactions can substantially delay seeking help in 20% of women.