What are the barriers and facilitators to timely diagnosis of endometriosis in adolescent and young adult women in high-income countries, as understood through the lens of the Capability, Opportunity, Motivation, and Behaviour (COM-B) model?

From the Guidelines

The timely diagnosis of endometriosis in adolescent and young adult women in high-income countries is hindered by capability, opportunity, and motivation barriers, which can be understood and addressed through the lens of the Capability, Opportunity, Motivation, and Behaviour (COM-B) model. When examining the barriers and facilitators to timely diagnosis, it is essential to consider the complex interplay of factors influencing this process. The COM-B model provides a useful framework for analyzing these factors, which include:

• Capability barriers, such as lack of knowledge and skills among healthcare providers to recognize and diagnose endometriosis 1
• Opportunity barriers, including limited access to specialized care and social support 1
• Motivation barriers, such as beliefs and emotions that may discourage women from seeking medical attention for their symptoms By applying the COM-B model, researchers and healthcare providers can identify specific intervention points to improve timely diagnosis and ultimately enhance the quality of life for women with endometriosis. For instance, interventions targeting capability barriers could focus on educating healthcare providers about endometriosis diagnosis and management, while those addressing opportunity barriers might aim to increase access to specialized care and social support. Similarly, interventions targeting motivation barriers could seek to raise awareness about endometriosis and its symptoms, reducing stigma and encouraging women to seek medical attention promptly. Overall, the COM-B model offers a valuable tool for understanding and addressing the complex factors influencing timely diagnosis of endometriosis in adolescent and young adult women.

From the Research

Barriers to Timely Diagnosis

• Delayed diagnosis due to diverse symptomatology and lack of a non-invasive diagnostic method 2, 3
• Invasive surgical procedure (laparoscopy) required for definitive diagnosis 2, 4
• Limited awareness and understanding of endometriosis among healthcare providers and patients 2, 5
• Focus on surgical findings and pelvic lesions rather than symptoms and clinical findings 2

Facilitators to Timely Diagnosis

• Increased patient education and awareness of endometriosis symptoms and treatment options 2, 5
• Timely referral to a women's healthcare provider and a shift in physician approach to the disorder 2
• Use of transvaginal ultrasonography and magnetic resonance imaging to evaluate endometriosis and rule out other causes of pelvic pain 4, 5
• Empiric therapy without immediate surgical diagnosis, as recommended by several gynecologic organizations 4, 6

Application of the COM-B Model

• Capability: Healthcare providers' knowledge and skills in diagnosing and managing endometriosis, as well as patients' understanding of the condition and its treatment options 2, 5
• Opportunity: Access to healthcare services, including specialized care and diagnostic tools, as well as social support and resources 4, 6
• Motivation: Patients' motivation to seek medical attention and adhere to treatment plans, as well as healthcare providers' motivation to provide timely and effective care 2, 5
• Behaviour: Healthcare providers' behaviour in diagnosing and managing endometriosis, as well as patients' behaviour in seeking medical attention and adhering to treatment plans 2, 5