What factors from the Theoretical Domains Framework influence people with cardiovascular disease to seek help from healthcare services? a systematic review, behavioural analysis and conceptual ‘KASiE’ considerations for five types of health-seeking behaviour

Background: Cardiovascular diseases (CVDs) are the biggest cause of premature deaths in the UK. The National Health Service (NHS) has identified CVDs as a key clinical area where many lives can be saved with preventative and early treatment services. Identifying what influences health help-seeking behaviour in people with CVDs can assist with the development of future intervention strategies. Methods: A systematic review synthesised qualitative, peer-reviewed literature reporting on the experiences of health service use from the perspective of people with CVDs from publications in four databases (PsycINFO, Medline, Embase, Emcare). The methodological quality of papers was assessed using the Critical Appraisal Skills Programme (CASP) checklist. Reported influences of health help-seeking were extracted as barriers or enablers, mapped to the Theoretical Domains Framework (TDF) and Capability, Opportunity, Motivation–Behaviour (COM-B) Model, and then followed by thematic analysis within each TDF domain. Results: 22 studies were included within the review. Influences on health help-seeking behaviour were coded to 10 of the 14 TDF domains, with most falling into Environmental Context and Resources, Knowledge, Social Influences, Beliefs about Consequences and Emotions. The prominent themes identified were related to the environment (healthcare service features, transport access, clashing life commitments), knowledge of CVDs and health service capabilities, social interactions (with social network and healthcare professionals), and emotions like fear and guilt linked to anticipated negative outcomes (e.g. fear of asking for help due to anticipation of doctors judging them as a ‘bad patient’). Conclusion: Those designing future interventions could consider the value of (1) increasing knowledge and awareness of CVD symptoms and management options, (2) improving logistical access to healthcare services, and (3) implementing strategies that promote positive social influences and challenge negative assumptions to address emotions such as guilt reported by those who may benefit from greater support. Together, we have termed this the KASiE (Knowledge, Access, Social influence and Emotions) approach highlighting areas for public health agencies to focus.