Determinants Of Delayed Care-Seeking In Acute Exacerbations Of COPD: Protocol

Determinants of delayed care-seeking in acute COPD exacerbations: a protocol-focused synthesis

The review aims to map determinants within Andersen’s Behavioral Model of Health Service Use, encompassing predisposing, enabling, and need-related factors.

• This article outlines a planned systematic review and meta-analysis to identify factors associated with delays in seeking professional care during acute exacerbations of chronic obstructive pulmonary disease (AECOPD).
• Delayed care-seeking is defined as the interval between onset or recognition of exacerbation symptoms and first contact with a healthcare professional or facility.

• The review will include observational analytic studies, spanning prospective or retrospective cohorts, case-control, and cross-sectional designs.
• Participants must be adults (≥18 years) with physician-diagnosed COPD who have experienced at least one AECOPD.
• Included studies must report a clear definition of delay and provide effect estimates or sufficient data to compute associations between determinants and delayed presentation or delay duration.
• Data synthesis plans accommodate meta-analysis when at least three studies offer comparable effect measures for the same determinant–outcome pairing; otherwise, synthesis will be narrative.

• Investigators will categorize determinants according to Andersen’s model axes: predisposing factors (e.g., demographic characteristics, beliefs, health norms), enabling factors (e.g., accessibility of care, social support, resources), and need-related factors (e.g., perceived severity of symptoms, comorbidity burden).
• The search strategy intends to capture a broad array of predictors across diverse settings, with no country or language restrictions feasible.

• The literature search will cover PubMed, Web of Science, CINAHL, Cochrane Library, and EMBASE from inception through the final search date.
• Supplementary methods include grey literature exploration, backward reference checks, and forward citation tracking to enhance comprehensiveness.

• Two independent reviewers will perform study selection and data extraction to minimize selection bias.
• Risk of bias will be evaluated using design-appropriate tools tailored to cohort, case-control, and cross-sectional studies.
• The protocol specifies handling heterogeneity by using random-effects models when three or more studies provide compatible effect measures for a determinant–outcome pair; otherwise, a narrative synthesis will be provided.

• The strength of evidence for key associations will be appraised using an adapted GRADE approach suitable for observational and prognostic data.
• The protocol notes that ethics approval is unnecessary because the synthesis relies solely on published, publicly available data and lacks any identifiable participant information.

• Findings are intended to inform clinicians, nurses, and policymakers about pivotal determinants of delayed care-seeking in AECOPD.
• The results are expected to support the development of theory-informed, targeted interventions to promote timely utilization of healthcare services.
• Dissemination will occur through publication in a peer-reviewed journal and presentation at relevant academic and clinical forums.

• The study is registered with PROSPERO (CRD420251244791), signaling pre-specified methods and analytic plans to reduce bias and enhance reproducibility.

• As a protocol, no empirical results are presented; the anticipated outcomes and effect estimates will depend on the available literature and the consistency of reported determinants across studies.