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

Objective
Identifying influences of help-seeking behaviour in people with cardiovascular diseases (CVDs) can assist with 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). Influences of help-seeking were mapped to the Theoretical Domains Framework (TDF) and Capability, Opportunity, Motivation – Behaviour (COM-B) Model, followed by thematic analysis.

Results
22 studies were included. Prominent themes 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 judgement as a ‘bad patient’).

Conclusion
Those designing future interventions could consider the value of 1) increasing knowledge of CVD symptoms and management options, 2) improving logistical access to services, and 3) implementing strategies that promote positive social influences and challenge assumptions to address emotions such as guilt. Together, we have termed this the KASiE (Knowledge, Access, Social influence and Emotions) approach highlighting areas for public health agencies to focus.