Understanding influences of care-seeking behaviors for diarrheal illnesses: A qualitative meta-synthesis

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.