Miller Marissa H, Hilbert Skye M, Rosser Erica N, Sinko Laura, Lee Elizabeth C, Wiens Kirsten E
Department of Epidemiology and Biostatistics, Temple University College of Public Health, Philadelphia, USA.
Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.
medRxiv. 2025 Jul 11:2025.07.08.25331122. doi: 10.1101/2025.07.08.25331122.
Diarrheal illnesses remain a leading cause of morbidity and mortality worldwide. Understanding when and where individuals seek healthcare is essential for accurately assessing disease burden and improving access to appropriate care. In this study, we conducted a meta-synthesis of qualitative research examining barriers and facilitators to care-seeking for diarrheal illness, either for individuals themselves or for their children. Specifically, we performed a systematic review of qualitative studies from any geographic location and time period that explored motivations for seeking care outside the home for diarrheal illness across all age groups. We then conducted a thematic analysis of the included studies to identify recurring patterns related to care-seeking behavior and to synthesize qualitative insights across contexts. In total, 47 studies met our inclusion criteria, the majority of which focused on caregiver decision-making for children with diarrhea in sub-Saharan Africa. Our meta-synthesis identified several key factors that influenced whether and when individuals sought care. Sociocultural norms, including locally held beliefs about disease causation, were frequently cited as influencing decisions to seek or delay formal care. Additional barriers included long travel distances to health facilities, transportation costs, limited trust in healthcare providers, negative feelings, and inconsistent availability of care. Conversely, episodes perceived as severe were more likely to prompt care-seeking outside the home. These findings highlight the importance of contextually grounded interventions that improve physical and financial access to care, foster trust in healthcare providers through consistent and effective service delivery and strengthen community engagement around recognizing signs of severe illness and the potential benefits of timely treatment. They also underscore the need for future studies to define diarrhea in locally relevant terms and to clearly define sources of care-seeking, as variation in these definitions can limit our full understanding of who is affected and how individuals respond to illness.
腹泻病仍然是全球发病和死亡的主要原因。了解个人何时何地寻求医疗保健对于准确评估疾病负担和改善获得适当护理的机会至关重要。在本研究中，我们对定性研究进行了元综合分析，以考察个人自身或其子女寻求腹泻病护理的障碍和促进因素。具体而言，我们对来自任何地理位置和时间段的定性研究进行了系统回顾，这些研究探讨了所有年龄组因腹泻病而在家庭外寻求护理的动机。然后，我们对纳入的研究进行了主题分析，以确定与寻求护理行为相关的反复出现的模式，并综合不同背景下的定性见解。总共有47项研究符合我们的纳入标准，其中大多数研究聚焦于撒哈拉以南非洲地区照顾腹泻儿童的决策。我们的元综合分析确定了几个影响个人是否以及何时寻求护理的关键因素。社会文化规范，包括当地对疾病病因的看法，经常被认为会影响寻求或延迟正规护理的决策。其他障碍包括前往医疗机构的路途遥远、交通费用、对医疗服务提供者的信任有限、负面情绪以及护理服务的可及性不一致。相反，被认为严重的情况更有可能促使人们在家庭外寻求护理。这些发现凸显了基于具体情况的干预措施的重要性，这些措施可改善获得护理的实际和经济机会，通过持续有效的服务提供培养对医疗服务提供者的信任，并加强社区在识别严重疾病迹象和及时治疗潜在益处方面的参与。它们还强调了未来研究需要用当地相关的术语来定义腹泻，并明确界定寻求护理的来源，因为这些定义的差异可能会限制我们对受影响人群以及个人对疾病反应的全面理解。
