Understanding influences of care-seeking behaviours for diarrhoeal illnesses: a qualitative meta-synthesis

Diarrhoeal 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. We conducted a meta-synthesis of qualitative research examining barriers and facilitators to care-seeking for diarrhoeal illness among individuals and caregivers of children.

We systematically reviewed qualitative studies examining the motivations for seeking care for diarrhoeal illness and conducted a thematic analysis to synthesise findings across studies.

PubMed, Embase, Web of Science and Global Index Medicus were searched through 3 September 2024.

We included qualitative studies that used interviews and/or focus group discussions to examine care-seeking decisions for diarrhoeal illness.

Two independent reviewers assessed studies for eligibility, extracted study information and coded factors influencing care-seeking decisions. The two researchers then independently created thematic trees based on patterns in the coded data and, through discussion with the full research team, synthesised findings into a thematic framework.

In total, 47 studies met our inclusion criteria, 36 of which focused on caregiver decision-making for children with diarrhoea in low- and middle-income countries. 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 recognising signs of severe illness and the potential benefits of timely treatment. They also underscore the need for future studies to define diarrhoea 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.