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 COM-B model is a suitable framework for understanding the barriers and facilitators to timely diagnosis of endometriosis in adolescent and young adult women in high-income countries, as it effectively analyzes the complex interplay of Capability, Opportunity, and Motivation that influence diagnostic delays. According to the American College of Radiology Appropriateness Criteria 1, endometriosis is a common condition with variable clinical presentation, and its diagnosis is often delayed due to a lack of understanding of its symptoms and limited access to healthcare. The COM-B model can help identify the behavioral determinants of diagnostic delays, including patient help-seeking behaviors, provider diagnostic behaviors, and system-level responses.

Key factors that contribute to diagnostic delays in endometriosis include:

• Limited knowledge about endometriosis symptoms among patients and healthcare providers, which affects their Capability to recognize and diagnose the condition 1
• Limited access to healthcare and societal normalization of menstrual pain, which reduces Opportunity for timely diagnosis 1
• Patient persistence in seeking diagnosis and provider willingness to investigate symptoms, which influences Motivation to address the condition 1

By applying the COM-B model, researchers can identify specific intervention points to address the 7-12 year average diagnostic delay for endometriosis in high-income countries, such as improving patient education and awareness, increasing access to healthcare, and enhancing provider training and willingness to investigate symptoms. This approach recognizes that improving diagnostic timeliness requires understanding and modifying behaviors of patients, healthcare providers, and healthcare systems, making COM-B an appropriate theoretical framework for addressing this complex issue.

From the Research

Barriers to Timely Diagnosis of Endometriosis

• Lack of knowledge and awareness among healthcare professionals, particularly in diagnosing endometriosis in young women 2
• Limited capability of sonologists to appreciate endometriosis on routine transvaginal US images, highlighting the need for improved imaging techniques 3
• Physical challenges, such as pain and discomfort, may also act as barriers to timely diagnosis 4
• Psychological co-morbidities, lack of knowledge, and awareness of endometriosis symptoms among patients can also hinder timely diagnosis 5

Facilitators to Timely Diagnosis of Endometriosis

• Increased awareness and education among healthcare professionals about endometriosis symptoms and diagnosis 2
• Improved imaging techniques, such as transvaginal US of the posterior compartment and observation of the relative positioning of the uterus and ovaries, can facilitate earlier detection 3
• Patient engagement, recent serious cases, or training can also facilitate referral and timely diagnosis 2
• Social support, access to practical resources, and availability of social support can also facilitate timely diagnosis and treatment 5

Application of the COM-B Model

• The COM-B model can be applied to understand the barriers and facilitators to timely diagnosis of endometriosis, including capability, opportunity, and motivation 4, 5, 6
• Psychological capability, such as lack of knowledge and awareness, can be a significant barrier to timely diagnosis 2, 5
• Physical opportunity, such as access to imaging techniques and healthcare services, can also impact timely diagnosis 3, 6
• Social opportunity, such as social support and stigma, can also influence timely diagnosis and treatment 5, 6